冠状动脉慢性完全闭塞病变患者经皮冠状动脉介入术后不同时程双联抗血小板药物治疗及预后观察

Different Durations of Dual Antiplatelet Therapy in Patients with Coronary Chronic Total Occlusion after Percutaneous Coronary Intervention and Prognosis

目的观察冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后不同时程双联抗血小板药物治疗(dual antiplatelet therapy,DAPT)及预后情况。方法选取PCI术后采用DAPT的冠状动脉CTO 480例,按照DAPT时程不同将其分为两组,采用DAPT>12个月方案者为延长DAPT组(274例),采用DAPT 12个月方案者为标准DAPT组(206例)。观察比较两组一般资料、DAPT用药情况及冠状动脉病变、PCI情况,记录比较两组随访主要和次要终点事件情况,应用Kaplan-Meier生存曲线和Log-Rank检验评估比较两组无主要不良心脑血管事件(major adverse cardiovascular and cerebrovascular events,MACCE)生存情况。结果延长DAPT组有PCI史所占比例高于标准DAPT组,差异有统计学意义(P<0.05)。两组其他一般资料及冠状动脉病变、PCI情况比较差异均无统计学意义(P>0.05)。采用阿司匹林加硫酸氢氯吡格雷方案延长DAPT组258例(94.2%)多于标准DAPT组172例(83.5%);采用阿司匹林加替格瑞洛方案延长DAPT组16例(5.8%)少于标准DAPT组34例(16.5%),差异有统计学意义(P<0.01)。延长DAPT组MACCE发生率和非致死性心肌梗死发生率低于标准DAPT组,差异有统计学意义(P<0.05)。Kaplan-Meier生存曲线分析结果显示,延长DAPT组无MACCE生存率高于标准DAPT组,差异有统计学意义(Log-Rank P<0.05)。结论冠状动脉CTO患者PCI术后50%以上选择延长DAPT,采用延长DAPT患者预后优于采用标准DAPT患者,且不增加中重度出血。

Objective To observe different duration of dual antiplatelet therapy(DAPT)in the treatment of patients with coronary chronic total occlusion(CTO)after percutaneous coronary intervention(PCI)and the prognosis.Methods A total of 480 coronary CTO patients who received DAPT after PCI were selected and divided into two groups according to the duration of DAPT.Those who received DAPT for more than 12 months were assigned to the prolonged DAPT group(n=274),and those who received DAPT for 12 months were assigned to the standard DAPT group(n=206).We observed and analyzed the general information,DAPT medication,coronary artery lesion and PCI.The primary and secondary endpoints of the two groups during the follow-up were recorded and compared,and Kaplan-Meier survival curve and Log-Rank test were used to evaluate and compare major adverse cardiovascular and cerebrovascular events(MACCE)-free survival of the two groups.Results The proportion of PCI history in the prolonged DAPT group was higher than that in the standard DAPT group(P<0.05).There was no significant difference in other general information,coronary artery lesion and PCI status between the two groups(P>0.05).In the prolonged DAPT group,258 cases(94.2%)were given aspirin plus clopidogrel bisulfate,who were more than 172 cases(83.5%)in the standard DAPT group;16 cases(5.8%)were given aspirin and ticagrelor,who were significantly fewer than 34 cases in the standard DAPT group(16.5%)(P<0.01).The incidence of MACCE and non-fatal myocardial infarction in the prolonged DAPT group were significantly lower than those in the standard DAPT group(P<0.05).Kaplan-Meier survival analysis showed that the MACCE-free survival rate in the prolonged DAPT group was significantly higher than that in the standard DAPT group(Log-Rank P<0.05).Conclusion Over 50%of the patients with coronary CTO after PCI chose to extend the duration of DAPT.Prognosis of patients undergoing prolonged DAPT treatment is better than those receiving standard DAPT treatment without increasing moderate to severe bleeding.