ST段抬高心肌梗死抗栓治疗及出血问题
胡舜英,陈韵岱
摘要(Abstract):
<正>斑块的不稳定、破裂与血栓形成是贯穿ST段抬高心肌梗死(STEMI)发病过程的主要矛盾。许多患者临床症状各异,但冠状动脉却具有非常相似的病理生理改变,即冠状动脉粥样硬化斑块由稳定转为不稳定,继而破裂导致血栓形成。血栓栓塞是动脉粥样硬化进展及并发症发生的重要因素,因此,STEMI的抗栓治疗非常重要,主要包括抗血小板聚集、抗凝和促纤溶等。然而,随着抗栓治疗的发展,出血并发症的发生也随之增多,出血事件对预后的
关键词(KeyWords): ST段抬高心肌梗死;抗栓治疗;出血
基金项目(Foundation): 国家自然科学基金资助项目(81102079)
作者(Author): 胡舜英,陈韵岱
参考文献(References):
- [1]中华医学会心血管病分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志,2010,38:675-689;
- [2]O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2013,61:e78-e140.
- [3]NdrepepaG,BergerPB,MehilliJ,et al.Periproceduralbleeding and 1-year outcome after percutaneous coronaryinterventions:appropriateness of including bleeding as acomponent of a quadruple end point.J Am Coll Cardiol,2008,51:690-697.
- [4]Rao SV,O'Grady K,Pieper KS,et al.Impact of bleedingseverity on clinical outcomes among patients with acute coronary syndromes.Am J Cardiol,2005,96:1200-1206.
- [5]Bovill EG,Terrin ML,Stump DC,et al.Hemorrhagicevents during therapy with recombinant tissue-type plasminogenactivator,heparin,and aspirin for acute myocardial infarction:results ofthe Thrombolysis in Myocardial Infarction(TIMI),phase II trial.AnnIntern Med,1991,115:256-265.
- [6]Wiviott SD,Braunwald E,McCabe CH,et al.Prasugrelversus clopidogrel in patients with acute coronary syndromes.N Engl J Med,2007,357:2001-2015.
- [7]Sabatine MS,Morrow DA,Giugliano RP,et al.Association of hemoglobin levels with clinical outcomes in acute coronary syndromes.Circulation,2005,111:2042-2049.
- [8]Eikelboom JW,Mehta SR,Anand SS,et al.Adverse impact of bleeding on prognosis in patients with acute coronary syndromes.Circulation,2006,114:774-782.
- [9]Amlani S,Nadarajah T,Afzal R,et al.Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction.J Thromb Thrombolysis,2010,30:434-440.
- [10]Kedhi E,Joesoef KS,McFadden E,et al.Second-generation everolimus-eluting and paclitaxel-eluting stents in real-life practice(COMPARE):a randomizedtrial.Lancet,2010,375:201-209.
- [11]Steinhubl SR,Kastrati A,Berger PB.Variation in the defi nitions of bleeding in clinical trials of patients with acute coronary syndromes and undergoing percutaneous coronary interventions and its impact on the apparent safety of antithrombotic drugs.Am Heart J,2007,154:3-11.
- [12]Stone GW,Midei M,Newman W,etal.Randomized comparison of everolimus-eluting and paclitaxel-eluting stents:two-year clinicalfollow-up from the clinical evaluation of the XIENCE V Everolimus Eluting coronary stent system in the treatment of patients with de novonative coronary artery lesions(SPIRITⅢ)trial.Circulation,2009,119:680-686.
- [13]Schulman S,Kearon C.Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.J Thromb Haemost,2005,3:692-694
- [14]Moscucci M,Fox KA,Cannon CP,et al.Predictors of major bleeding in acute coronary syndromes:the Global Registry of Acute Coronary Events(GRACE).Eur Heart J,2003,24:1815-1823.
- [15]Spencer FA,Moscucci M,Granger CB,et al.Does comorbidity account for the excess mortality in patients with major bleeding in acute myocardial infarctionCirculation,2007,116:2793-2801.
- [16]Feit F,Voeltz MD,Attubato MJ,et al.Predictors and impact of major hemorrhage on mortality following percutaneous coronary intervention from the REPLACE-2Trial.Am J Cardiol,2007,100:1364-1369.
- [17]Budaj A,Eikelboom JW,Mehta SR,et al.Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes.Eur Heart J,2009,30:655-661.
- [18]Amlani S,Nadarajah T,Afzal R,et al.Mortality and morbidity following a major bleed in a registry populationwith acute ST elevation myocardial infarction.J Thromb Thrombolysis,2010,30:434-440.
- [19]Rao SV,McCoy LA,Spertus JA,et al.An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention:a report using an expanded bleeding defi nition from the National Cardiovascular Data Registry CathPCI Registry.JACC Cardiovasc Interv,2013,6:897-904.
- [20]Mehran R,Rao SV,Bhatt DL,et al.Standardized bleeding defi nitions for cardiovascular clinical trials:a consensus report from the Bleeding Academic Research Consortium.Circulation,2011,123:2736-2747.
- [21]李世英,柳景华.欧美出血学术研究会(BARC)关于出血的统一定义.中国介入心脏病学杂志,2012,20:231-234。
- [22]Boden H,Velders MA,van der Hoeven BL et al.In-hospital major bleeding and its clinical relevance in patients with ST elevation myocardial infarction treated with primary percutaneous coronary intervention.Am J Cardiol,2013,112:1533-1539.
- [23]Eikelboom JW,MenthaSR,AnandSS,et al.Adverse impact of bleeding on prognosis in patients with acute coronary syndromes.Circulation,2006,114:774-782.
- [24]Rao SV,Jollis JG,Harrington RA,et al.The relationship of blood transfusion and clinical outcomes in patient with acute coronary syndromes.JAMA,2004,292:1555-1562.
- [25]Stone GW,Clayton T,Deliargyris EN,et al.Reduction in cardiac mortality with bivalirudin in patients with and without major bleeding:The HORIZONS-AMI trial(Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction).J Am Coll Cardiol,2014,63:15-20.
- [26]Cayla G,Silvain J,O'Connor SA,et al.An evidence-based review of current anti-platelet options for STEMI patients.Int J Cardiol,2013,166:294-303.
- [27]Bottorff MB,Nutescu EA,Spinler S.Antiplatelet therapy in patients with unstable angina and non-ST-segment-elevation myocardial infarction:fi ndings from the CRUSADE national quality improvement initiative.Pharmacotherapy,2007,27:1145-1162.
- [28]Stiles MK,Dabbous OH,Fox KA,et al.Bleeding events with antithrombotic therapy in patients with unstable angina or non-STsegment elevation myocardial infarction insight from a large clinical practice registry(GRACE).Heart Lung Circ,2008,17:5-8.
- [29]Yusuf S,Zhao F,Mehta SR,et al.Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without STsegment elevation.N Engl J Med,2001,345:494-502.
- [30]Lim MJ,Eagle KA,Gore JM,et al.Treating patients with acute coronary syndromes with aggressive antiplatelet therapy(from the Global Registry of Acute Coronary Events).Am J Cardiol,2005,96:917-921.
- [31]Subherwal S,Bach RG,Chen AY,et al.Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction:the CRUSADE(Can Rapid risk stratifi cation of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines)Bleeding Score.Circulation,2009,119:1873-1882.
- [32]Mehran R,Pocock SJ,Nikolsky E,et al.A risk score to predict bleeding in patients with acute coronary syndromes.J Am Coll Cardiol,2010,255:2556-2566.
- [33]Mathews R,Peterson ED,Chen AY,et al.In-hospital major bleeding during ST-elevation and non-ST-elevation myocardial infarction care:derivation and validation of a model from the ACTION Registry-GWTG.Am J Cardiol,2011,107:1136-1143.