张宇超,王韶屏,柳景华

• 1:首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所

摘要(Abstract)：

双联抗血小板治疗(DAPT)是经皮冠状动脉介入治疗(PCI)术后药物治疗的基石。近年来,随着越来越多复杂PCI的开展,对于接受复杂PCI的患者如何制定有效且安全的DAPT策略已成为当下研究的热点。接受复杂PCI的患者往往伴随着更高的缺血风险,然而延长DAPT的时间会增加患者的出血风险。换用新型P2Y12抑制剂可能提供了一种新的策略。本文围绕当代复杂PCI现状、优化DAPT时长和强度的临床以及相关理论研究进行综述。

关键词(KeyWords)： 经皮冠状动脉介入治疗;双联抗血小板治疗;复杂冠状动脉病变

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金（81970291）;; 国家重点基础研究发展计划（973计划）（2015CB554404）

作者(Author): 张宇超,王韶屏,柳景华

参考文献(References)：

• [1]Levine GN,Bates ER,Bittl JA,et al.2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease:a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.J Am Coll Cardiol,2016,68(10):1082-1115.
• [2]Neumann FJ,Sousa-Uva M,Ahlsson A,et al.2018 ESC/EACTSGuidelines on myocardial revascularization.Eur Heart J,2019,40(2):87-165.
• [3]中华医学会心血管病学分会介入心脏病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南（2016）.中华心血管病杂志，2016,44(5):382-400.
• [4]Généreux P,Giustino G,Witzenbichler B,et al.Incidence,predictors,and impact of post-discharge bleeding after percutaneous coronary intervention.J Am Coll Cardiol,2015,66(9):1036-1045.
• [5]Giustino G,Baber U,Sartori S,et al.Duration of dual antiplatelet therapy after drug-eluting stent implantation:a systematic review and Meta-analysis of randomized controlled trials.J Am Coll Cardiol,2015,65(13):1298-1310.
• [6]Mehran R,Giustino G,Baber U.DAPT duration after DES:what is the"mandatory"duration?J Am Coll Cardiol,2015,65(11):1103-1106.
• [7]Genereux P,Giustino G,Redfors B,et al.Impact of percutaneous coronary intervention extent,complexity and platelet reactivity on outcomes after drug-eluting stent implantation.Int J Cardiol,2018,268:61-67.
• [8]Serruys PW,Takahashi K,Chichareon P,et al.Impact of longterm ticagrelor monotherapy following 1-month dual antiplatelet therapy in patients who underwent complex percutaneous coronary intervention:insights from the Global Leaders trial.Eur Heart J,2019,40(31):2595-2604.
• [9]Yeh RW,Kereiakes DJ,Steg PG,et al.Lesion complexity and outcomes of extended dual antiplatelet therapy after percutaneous coronary intervention.J Am Coll Cardiol,2017,70(18):2213-2223.
• [10]Yamamoto K,Shiomi H,Morimoto T,et al.Ischemic and bleeding risk after complex percutaneous coronary intervention in patients with or without high bleeding risk.Catheter Cardiovasc Interv,2020,97(6):E758-E770.
• [11]Giustino G,Chieff o A,Palmerini T,et al.Effi cacy and safety of dual antiplatelet therapy after complex PCI.J Am Coll Cardiol,2016,68(17):1851-1864.
• [12]Dangas G,Baber U,Sharma S,et al.Ticagrelor with or without aspirin after complex PCI.J Am Coll Cardiol,2020,75(19):2414-2424.
• [13]Costa F,Van Klaveren D,Feres F,et al.Dual antiplatelet therapy duration based on ischemic and bleeding risks af ter coronary stenting.J Am Coll Cardiol,2019,73(7):741-754.
• [14]Valgimigli M,Bueno H,Byrne RA,et al.2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS:the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J,2017,39(3):213-260.
• [15]Landes U,Bental T,Levi A,et al.Temporal trends in percutaneous coronary interventions thru the drug eluting stent era:insights from 18,641 procedures performed over 12-year period.Catheter Cardiovasc Interv,2018,92(4):E262-E270.
• [16]Kirtane AJ,Doshi D,Leon MB,et al.Treatment of higherrisk patients with an indication for revascularization:evolution wit hin t he f ield of con tem pora r y percu ta neous corona r y intervention.Circulation,2016,134(5):422-431.
• [17]Werner N,Nickenig G,Sinning JM.Complex PCI procedures:challenges for the interventional cardiologist.Clin Res Cardiol,2018,107(Suppl 2):64-73.
• [18]Baber U,Mehran R,Giustino G,et al.Coronary thrombosis and major bleeding after PCI with drug-eluting stents:risk scores from PARIS.J Am Coll Cardiol,2016,67(19):2224-2234.
• [19]Subhaharan D,Mridha N,Singh K.Clinical benefi ts of prolonged dual antiplatelet therapy following complex percutaneous coronary intervention.Coron Artery Dis,2020,31(3):273-278.
• [20]Mehran R,Baber U,Sharma SK,et al.Ticagrelor with or without aspirin in high-risk patients after PCI.N Engl J Med,2019,381(21):2032-2042.
• [21]Baber U,Zafar MU,Dangas G,et al.Ticagrelor with or without aspirin after PCI:the TWILIGHT platelet substudy.J Am Coll Cardiol,2020,75(6):578-586.
• [22]Santos-Gallego CG,Badimon J.Duration of antiplatelet therapy af ter complex PCI in the TWILIGHT-COMPLEX trial:the goldilocks dilemma.Cardiovasc Res,2020,116(8):e93-e95.
• [23]Navarese EP,Andreotti F,Schulze V,et al.Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents:Meta-analysis of randomised controlled trials.BMJ,2015,350:h1618.
• [24]Mauri L,Kereiakes DJ,Yeh RW,et al.Twelve or 30 months of dual antiplatelet therapy af ter drug-eluting stents.N Engl JMed,2014,371(23):2155-2166.
• [25]Chen H,Power D,Giustino G.Optimal duration of dual antiplatelet therapy after PCI:integrating procedural complexity,bleeding risk and the acuteness of clinical presentation.Expert Rev Cardiovasc Ther,2018,16(10):735-748.
• [26]Suh J,Park DW,Lee JY,et al.The relationship and threshold of stent length with regard to risk of stent thrombosis after drugeluting stent implantation.JACC Cardiovasc Interv,2010,3(4):383-389.
• [27]Piccolo R,Giustino G,Mehran R,et al.Stable coronary artery disease:revascularisation and invasive strategies.Lancet,2015,386(9994):702-713.
• [28]Maeng M,Holm NR,Erglis A,et al.Long-term results after simple versus complex stenting of coronary artery bif urcation lesions:Nordic Bifurcation Study 5-year follow-up results.J Am Coll Cardiol,2013,62(1):30-34.
• [29]Xaplanteris P,Fournier S,Pijls NHJ,et al.Five-year outcomes with PCI guided by fractional fl ow reserve.N Engl J Med,2018,379(3):250-259.
• [30]Kawase Y,Matsuo H,Akasaka T,et al.Clinical use of physiological lesion assessment using pressure guidewires:an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics.Cardiovasc Interv Ther,2019,34(1):85-96.
• [31]Hong SJ,Shin DH,Kim JS,et al.6-month versus 12-month dual-antiplatelet therapy f ollowing long everolimus-eluting stent implantation:the IVUS-XPL randomized clinical trial.JACCCardiovasc Interv,2016,9(14):1438-1446.
• [32]Zhang J,Gao X,Kan J,et al.Intravascular Ultrasound versus angiography-guided drug-eluting stent implantation:the ULTIMATE trial.J Am Coll Cardiol,2018,72(24):3126-3137.
• [33]Elgendy IY,Mahmoud AN,Elgendy AY,et al.Intravascular ultrasound-guidance is associated with lower cardiovascular mortality and myocardial inf arction f or drug-eluting stent im pla ntation-insights f rom a n u pdated Meta-a nalysis of randomized trials.Circ J,2019,83(6):1410-1413.
• [34]Sonoda S,Hibi K,Okura H,et al.Current clinical use of intravascular ultrasound imaging to guide percutaneous coronary interventions.Cardiovasc Interv Ther,2020,35(1):30-36.
• [35]高睿，于波.光学相干断层成像在冠状动脉分叉病变中的应用.中国介入心脏病学杂志，2020,28(5):283-285.
• [36]Capodanno D,Mehran R,Valgimigli M,et al.Aspirinfree strategies in cardiovascular disease and cardioembolic stroke prevention.Nat Rev Cardiol,2018,15(8):480-496.
• [37]Redfors B,Ben-Yehuda O,Lin SH,et al.Quantifying ischemic risk after percutaneous coronary intervention attributable to high platelet reactivity on clopidogrel (f rom the assessment of dual antiplatelet therapy with drug-eluting stents study).Am J Cardiol,2017,120(6):917-923.
• [38]Ibrahim H,Schutt RC,Hannawi B,et al.Association of immature platelets with adverse cardiovascular outcomes.J Am Coll Cardiol,2014,64(20):2122-2129.
• [39]Chitalia VC,Shivanna S,Martorell J,et al.Uremic serum and solutes increase post-vascular interventional thrombotic risk through altered stability of smooth muscle cell tissue factor.Circulation,2013,127(3):365-376.