有高血压脑出血史的患者冠状动脉介入术标准双抗治疗预后影响因素分析

Identifying factors related to prognosis in hypertensive patients with standard dual antiplatelet therapy undergoing percutaneous coronary intervention

目的:心脏支架置入术后要求使用双重抗血小板治疗(dual antiplatelet therapy DAPT),而脑出血后使用抗血小板治疗仍然存在争议。本研究旨在评估有高血压脑出血病史者,对使用双重抗血小板(双抗)治疗的经皮冠状动脉介入(percutaneous coronary intervention PCI)术后患者预后的影响。方法:本研究为观察性临床研究,纳入有高血压脑出血病史的PCI患者128例作为观察组,有高血压但无脑出血病史的PCI患者153例作为对照者。所有患者在PCI术后均服用阿司匹林100mg和氯吡格雷75mg治疗,随访时间为12~48个月。疗效结局为主要不良心脑血管病事件,安全性结局为再发脑出血和主要出血。结果:共随访到228例患者,其中观察组102例,对照组126例。既往脑出血病史(HR:1.998,95%CI:1.164~3.415,P=0.012)和冠心病病史(HR:2.664,95%CI:1.388~5.111,P=0.003)是导致高血压的PCI患者,双抗治疗下主要不良心脑血管病事件的危险因素。既往脑出血病史并未增加高血压的PCI患者,双抗治疗下再发脑出血(HR:2.292,95%CI:0.368~14.254,P=0.199)和主要出血的风险(HR:1.467,95%CI:0.475~4.536,P=0.506)。结论:脑出血病史和冠心病病史,是高血压的PCI患者双抗治疗下主要不良心脑血管病事件的危险因素。脑出血病史的高血压患者,PCI术后,在标准双抗治疗下,再发脑出血和主要出血的风险未增加,但明显增加主要不良心脑血管病事件的风险,需予以关注。

Objective:Dual antiplatelet therapy(DAPT)is required after cardiac stent implantation,but the use of antiplatelet therapy after cerebral hemorrhage is still controversial.The aim of this study is to evaluate the impact of hypertensive cerebral hemorrhage on the prognosis of patients with standard dual antiplatelet therapy undergoing percutaneous coronary intervention(PCI).Methods:An observational clinical study involving 128 cases and 153 controls were selected from in-patients with cardiac stenting on dual antiplatelet therapy.all patients took asprin 100mg plus clopidogrel 75mg after PCI and were followed-up for a duration of 12-48months.the primary outcomes were recurrent intracerebral hemorrhage(ICH),major bleeding and major adverse cardiovascular and cerebrovascular events(MACCE).Results:A history of hypertensive cerebral hemorrhage was not risk factor for recurrent ICH(HR:2.292,95%CI:0.368–14.254,P=0.199)and major bleeding(HR:1.467,95%CI:0.475–4.536,P=0.506)on dual antiplatelet therapy.However both a history of hypertensive cerebral hemorrhage(HR:1.998,95%CI:1.164–3.415,P=0.012)and coronary heart disease(HR:2.664,95%CI:1.388–5.111,P=0.003)were independent risk factors for MACCE.Conclusions:in PCI patients taking dual antiplatelet therapy.A history of hypertensive cerebral hemorrhage was not a risk factor for recurrent ICH and major bleeding.While a history of hypertensive cerebral hemorrhage was an independent risk factor for MACCE,requires special attention.