延长双联抗血小板治疗时程对急性冠状动脉综合征行经皮冠状动脉介入治疗患者预后的作用

Effect of prolonged dual antiplatelet therapy duration on the prognosis of patients with acute coronary syndrome after percutaneous coronary intervention

目的探讨延长双联抗血小板治疗(DAPT)时程对急性冠状动脉综合征(ACS)行经皮冠状动脉介入治疗(PCI)患者预后的影响。方法入选2017年6月至2022年8月在廊坊市人民医院住院行PCI的ACS患者1175例,所有患者均接受标准12个月的DAPT治疗且未发生主要不良心脑血管事件(MACCE)和出血事件。根据患者是否继续延长DAPT时程,将患者分为标准治疗组545例和延长双抗组630例。标准治疗组DAPT时程为12个月,延长双抗组延长DAPT时程至术后18~24个月,随访至术后24个月。研究的主要终点为随访期间发生的MACCE,包括心源性死亡、心肌梗死、脑卒中和缺血驱动的再次血运重建的复合终点,次要终点为出血事件,包括大出血和小出血事件。结果和标准治疗组患者相比,延长双抗组患者MACCE发生率降低,差异有统计学意义(χ^(2)=3.892,P<0.05)。在安全性方面,延长双抗组出血事件增加(χ^(2)=7.475,P<0.01),主要归因于小出血事件的增加(χ^(2)=6.061,P<0.05)。Cox回归分析显示,患者的病变血管支数是MACCE发生的影响因素(HR=0.389,P<0.01)。结论对于行PCI治疗的ACS患者,与标准12个月的DAPT时程相比,延长DAPT时程至18~24个月,可降低患者MACCE的发生但增加了患者小出血的风险。

Objective To investigate the effect of extending dual antiplatelet therapy(DAPT)duration on the prognosis of patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 1175 patients with ACS who underwent PCI at Langfang People's Hospital from June 2017 to August 2022 were selected.All patients received standard DAPT treatment for 12 months without experiencing major adverse cardiovascular and cerebrovascular events(MACCE)or bleeding events.Patients were divided into the standard treatment group(545 cases)and the prolonged dual antiplatelet group(630 cases)according to whether they extended DAPT duration.The standard treatment group received a 12-month DAPT regimen,while the prolonged dual antiplatelet group extended DAPT duration to 18-24 months postoperatively,followed up for 24 months.The primary endpoint of the study was the occurrence of MACCE during follow-up,including a composite end point of cardic death,myocardial infarction,stroke,and ischemia-driven revascularization.The primary safety endpoint was bleeding events,including major and minor bleeding events.Results Compared with the standard treatment group,the prolonged dual antiplatelet group showed a reduction in the incidence of MACCE,with a ststistically significant difference(χ2=3.892,P<0.05).In terms of safety,the prolonged dual antiplatelet group exhibited a significant increase in bleeding events(χ2=7.475,P<0.01),mainly attributed to the increase in minor bleeding events(χ2=6.061,P<0.05).Cox regression analysis showed that the number of diseased vessels was an independent predictor for MACCE occurrence(HR=0.389,P<0.01).Conclusion For ACS patients undergoing PCI,compared to the standard 12-month DAPT regimen,extending DAPT duration to 18-24 months can reduce the occurrence of MACCE,but increases the risk of minor bleeding in patients.