不同抗血小板治疗方案对急性冠状动脉综合征合并基线血小板中度减少患者预后的影响

Effects of different antiplatelet therapies on prognosis in patients with acute coronary syndrome and moderate thrombocytopenia

目的:探讨不同抗血小板治疗方案对急性冠状动脉综合征(ACS)合并基线血小板中度减少(mTP)患者的再发心肌梗死及出血事件的影响。方法:回顾性入选2017年8月—2019年11月于郑州大学第一附属医院住院的ACS合并基线mTP患者418例,根据不同抗血小板方案分为单抗组和双抗组。收集入选患者临床基线资料,采用倾向性评分匹配(PSM)获得基线资料相似的两组人群。主要终点:心肌梗死和出血事件,出血事件定义为TIMI大出血和TIMI小出血的复合指标;次要终点:心血管源性死亡、支架内血栓形成、再血管化治疗、脑梗死、BARC 5型出血、BARC 3型出血、脑出血及消化道出血。采用Kaplan-Meier法拟合两组患者心血管源性死亡的生存曲线。对该部分人群进行随访,终点事件的观察截至2020年5月31日。结果:在418例患者中,有单抗组106例及双抗组106例患者匹配良好,观察并分析终点事件。随访6个月内,双抗组的心肌梗死发生率低于单抗组(2.8%∶11.3%,P<0.05);出血事件发生率高于单抗组(16.0%∶3.8%,P<0.01),其中两组间TIMI大出血发生率差异无统计学意义(P>0.05),但双抗组TIMI小出血发生率高于单抗组(9.4%∶1.9%,P<0.05)。两组心血管源性死亡的Kaplan-Meier生存曲线差异无统计学意义(P>0.05)结论:ACS合并基线mTP患者,双联抗血小板治疗较单抗治疗可在不增加大出血事件风险的同时,有效减少心肌梗死发生率。

Objective:To assess the effects of different antiplatelet therapies on myocardial infarction and bleeding events among patients diagnosed with the acute coronary syndrome(ACS)and moderate thrombocytopenia.Methods:We performed a retrospective study of 418 patients with ACS and moderate thrombocytopenia who were hospitalized in the First Affiliated Hospital of Zhengzhou University between August 2017 to November 2019.All patients were divided into 2 groups:monotherapy group and dual antiplatelet therapy(DAPT)group.Clinical baseline data were collected through an electronic medical record system,and Propensity Score Matching(PSM)was used to ensure the two groups’comparability.The primary endpoint was a composite of myocardial infarction(MI)and hemorrhagic events with the latter defined as TIMI major or minor bleeding.The secondary endpoints included cardiovascular death,stent thrombosis,revascularization,cerebral infarction,BARC type 5 bleeding,BARC type 3 bleeding,cerebral hemorrhage,and gastrointestinal hemorrhage.The survival curve of patients with cardiovascular death in the two groups was fitted by the Kaplan-Meier method.These patients were followed up until May 2020,and at least for 6 months.Results:Among the 418 eligible patients,106 patients in the monotherapy group and 106 in the DAPT group had similar propensity scores and were included in the analyses.At the end of follow-up,the prevalence of myocardial infarction was 11.3%(12/106)in the monotherapy group and 2.8%(3/106)in the DAPT group(P<0.05).Percent of bleeding events was 16.0%(17/106)in the DAPT group,and 3.8%(4/106)in the monotherapy group(P<0.01).There was no difference in the incidence of TIMI major bleeding between the two groups(P>0.05).However the incidence of TIMI minor bleeding in the DAPT group was 9.4%(10/106),which was higher than that in the monotherapy group 1.9%(2/106)(P<0.05).There was no difference in Kaplan-Meier survival curves for cardiovascular deaths between the monotherapy and DAPT group(P>0.05).Conclusion:In ACS patients complicated with moderate baseline thrombocytopenia,dual antiplatelet therapy was more effective than monotherapy in reducing the incidence of myocardial infarction without increasing the risk of major bleeding events.