冠心病PCI术后停用抗血小板治疗患者的长期预后

Long-term prognosis of patients with coronary heart disease who discontinued antiplatelet therapy after percutaneous coronary intervention

目的探讨冠心病经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后停用抗血小板治疗患者的长期预后。方法选择2014年1月30日-2017年1月30日在枣庄市妇幼保健院内科心内科住院接受PCI治疗的300例冠心病患者作为研究对象。根据PCI术后停止抗血小板治疗情况,将患者分为<6个月停药组(PCI术后6个月内停止抗血小板药物治疗)、6〜12个月停药组(PCI术后6〜12个月停止抗血小板药物治疗)、>12个月停药组(PCI术后>12个月后停止抗血小板药物治疗)。对患者进行随访,随访终点为不良心血管事件。比较三组患者不良心血管事件发生情况。结果三组患者间年龄、性别、吸烟情况、体质量指数、合并高血压、合并糖尿病、血脂水平、血糖水平差异无统计学意义(P>0.05)。随访30-65个月,中位随访时间42.4个月,在258例停用抗血小板药物患者中发生39例不良心血管事件。<6个月停药组不良心血管事件总发生率(57.89%)高于6〜12个月停药组(13.13%)、>12个月停药组(10.71%),差异有统计学意义(x^(2)=29.516,P=0.000)。三组需再次血运重建发生率、心源性死亡发生率差异有统计学意义(P<0.05)。Kaplan-Meier并Log-rank检验显示,<6个月停药组不良心血管事件生存时间短于6〜12个月停药组、>12个月停药组(Log-rank x^(2)=34.218,P=0.000)。258例停用抗血小板药物患者中不良心血管事件发生率为15.12%,高于未停抗血小板药物患者(2.5%),差异有统计学意义(P<0.05)。结论PCI术后停止抗血小板治疗患者较多,服药依从性差,且停用抗血小板治疗者不良心血管事件发生率高。

Objective To investigate the long-term prognosis of patients with coronary heart disease who discontinued antiplatelet therapy after percutaneous coronary intervention(PCI).Methods 300 patients with coronary heart disease who underwent PCI were divided into 3 groups:<6 months group who discontinued antiplatelet therapy within 6 months after PCI,6〜12 months group who discontinued antiplatelet therapy during the period of 6〜12 months after PCI,and>12 months group who discontinued antiplatelet therapy after one year after PCI.The patients were followed up until the occurrence of an adverse cardiovascular event with a mean follow-up time of 42.4 months.The incidence of adverse cardiovascular events was compared between the three groups.Results There were no significant differences in age,gender,smoking status,body mass index,hypertension,diabetes mellitus,blood lipid levels and blood glucose levels among the three groups(all P>0.05).The patients was followed up to 30〜65 months,with a median follow-up time of 42.4 months,Theoccurrence rate of adverse cardiovascular events of the patients who discontinued the anti-platelet therapy was 15.12%(39/258),significantly higher than that of the patients who didn't discontinued the anti-platelet therapy(1/40,2.5%,P<0.05).The total incidence of adverse cardiovascular events in the 6-month withdrawal group(57.89%)wassignificantly higher than those in the 6〜12 months discontinuation group(13.13%)and>12 months discontinuation group(10.71%,x^(2)=29.516,F=0.000).There was a statistically significant difference in the incidence of revascularization and the incidence of cardiac death between the three groups(P<0.05).Kaplan-Meier and Log-rank test showed that the survival time of adverse cardiovascular events in the 6-month withdrawal group was significantly shorter than those of the 6~12 months in the withdrawal group and>12 months in the withdrawal group(Log-rank x^(2)=34.218,P=0.000).Conclusion There are many patients who stop antiplatelet therapy after PCI,with a poor medication compliance,and the incidence of adverse cardiovascular events is high in the patients who stop using antiplatelet therapy.