75岁以上老年冠心病患者PCI后双联抗血小板治疗疗效、安全性及预后研究

Curative effect and safety of dual antiplatelet therapy and prognosis study in patients aged over 75 with CHD after PCI

目的探讨不同双联抗血小板(DAPT)治疗策略对老年患者经皮冠状动脉介入术(PCI)后的有效性及安全性。方法本研究纳入2014年2月至2018年10月因心绞痛、心电图改变等原因至我院行冠状动脉(冠脉)造影的老年(年龄≥75岁)患者300例,随机分为DAPT 3月组与12月组,药物洗脱支架(DES)植入后10~12个月进行冠脉造影和临床随访,评估两组间术后短期出血事件和主要不良心血管事件(MACE)发生率的差异。结果3月组与12月组的MACE:心源性死亡(0%vs.0.71%,χ^(2)=1.131,P=0.287),心肌梗死(1.89%vs.1.42%,χ^(2)=0.100,P=0.752),靶病变血运重建(8.81%vs.9.93%,χ^(2)=0.112,P=0.738),支架内再狭窄(χ^(2)=2.502,P=0.114),BARC 3-5型出血事件(χ^(2)=2.223,P=0.136)等无统计学差异。DAPT 3月组BARC 1-2级出血事件发生率显著低于12月组(18.87%vs.29.08%,χ^(2)=4.312,P=0.038)。结论老年冠心病患者DES植入后3个月可考虑终止DAPT,从而降低出血风险。

Objective To discuss the curative effect and safety of dual antiplatelet therapy(DAPT)in different therapeutic strategies in elderly patients after PCI.Methods The patients(aged≥75,n=300)hospitalized due to angina and changed ECG and received coronary angiography(CAG)were chosen from People’s Hospital of Langfang City from Feb.2014 to Oct.2018,and divided randomly into 3-month DAPT group and 12-month DAPT group.After implantation of drug eluting stent(DES)for 10~12 months,the patients were given CAG examination and clinical follow-up.The differences in the incidence rates of postoperative short-term bleeding events and major adverse cardiovascular events(MACE)were reviewed between 2 groups.Results The comparison in MACE showed that cardiac death(0%vs.0.71%,χ^(2)=1.131,P=0.287),myocardial infarction(1.89%vs.1.42%,χ^(2)=0.100,P=0.752),target lesion revascularization rate(8.81%vs.9.93%,χ^(2)=0.112,P=0.738),in-stent restenosis(χ^(2)=2.502,P=0.114)and type BARC 3-5 bleeding events(χ^(2)=2.223,P=0.136)had no statistical difference between 2 groups.The incidence rates of type BARC 1-2 bleeding events were significantly lower in 3-month DAPT group than those in 12-month DAPT group(18.87%vs.29.08%,χ^(2)=4.312,P=0.038).Conclusion DAPT can be safely discontinued after DES implantation for 3 months for reducing bleeding risk.