药物洗脱支架术后双联抗血小板药物应用二年与一年的比较Comparison of two year duration versus one year duration of dual antiplatelet therapy after drug-eluting stent implantation on major adverse cardiac event
唐秀革,周卓东,花冠杰,韦利元,申勇
摘要(Abstract):
目的对比置入药物洗脱支架(DES)后双联抗血小板治疗2年相比1年能否降低主要不良心血管事件。方法入选2006年1月至2007年12月行DES的患者221例,按照双联抗血小板治疗1年和2年分为2组,初级终点为主要不良心血管事件(心源性死亡、非致命性心肌梗死、靶血管再次血运重建的联合终点)。结果截止至2009年12月的随访结果显示服用氯吡格雷1年组和2年组的主要不良心血管事件发生率分别为4.3%和4.7%,P=0.80。结论置入DES术后延长双联抗血小板治疗时间至2年相比1年并未降低主要不良心血管事件。
关键词(KeyWords): 氯吡格雷;药物洗脱支架;血管成形术,经腔,经皮冠状动脉
基金项目(Foundation):
作者(Author): 唐秀革,周卓东,花冠杰,韦利元,申勇
参考文献(References):
- [1]King SB3rd,Smith SC Jr,Hirshfeld JW Jr,et al.2007focused update of the ACC/AHA/SCAI2005guideline update for percutaneous coronary intervention:a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines.J Am Coll Cardiol,2008,51:172-209.
- [2]Banerjee S,Varghese C,Samule J,et al.Comparison of the impact of short(<1year)and long-term(>or=1year)clopidogrel use following percutaneous coronary intervention on mortality.Am J Cardiol,2008,102:1159-1162.
- [3]Butler MJ,Eccleston D,Clark DJ,et al.The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents.Am Heart J,2009,157:899-907.
- [4]Liistro F,Colombo A.Late acute thrombosis after paclitaxel eluting stent implantation.Heart,2001,86:262-264.
- [5]Kerner A,Gruberg L,Kapeliovich M,et al.Late stent thrombosis after implantation of a sirolimus-eluting stent.Catheter Cardiovasc Interv,2003,60:505-508.
- [6]Pasceri V,Pelliccia F,Cianfrocca C,et al.Very late thrombosis after sirolimus-eluting stent implantation.J Cardiovasc Med,2006,7:438-442.
- [7]Eisenstein EL,Anstrom KJ,Kong DF,et al.Clopidogrel use and long-term clinical outcome after drug-eluting stent implantation.JAMA,2007,297:159-168.
- [8]Beohar N,Davidson CJ,Kip KE,et al.Outcomes and complications associated with off-label and untested use of drug-eluting stents.JAMA,2007,297:1992-2000.
- [9]Mehta SR,Yusuf S,Peters RJ,et al.Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention:the PCI-CURE study.Lancet,2001,358:527-533.
- [10]Steinhubl SR,Berger PB,Mann JT3rd,et al.Early and sustained dual oral antiplatelettherapy following percutaneous coronary intervention:a randomized controlled trial.JAMA,2002,288:2411-2420.
- [11]Sabatine MS,Cannon CP,Gibson CM,et al.Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics:the PCI-CLARITY study.JAMA,2005,294:1224-1232.
- [12]Yusuf S,Zhao F,Mehta SR,et al.Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation.N Engl J Med,2001,16,345:494-502.
- [13]No authors listed.A randomized,blinded,trial of clopidogrel versus aspirin in patients at risk of ischemic events(CAPRIE).CAPRIE Steering Committee.Lancet,1996,348:1329-1339.
- [14]Iakovou I,Schmidt T,Bonizzoni E,et al.Incidence,predictors,and outcome of thrombosis after successful implantation of drug-eluting stents.JAMA,2005,293:2126-2130.
- [15]McFadden EP,Stabile E,Regar E,et al.Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy.Lancet,2004,364:1519-1521.
- [16]Roy P,Bonello L,Torguson R,et al.Temporal relation between clopidogrel cessation and stent thrombosis after drug-eluting stent implantation.Am J Cardiol,2009,103:801-805.
- [17]Park DW,Yun SC,Lee SW,et al.Stent thrombosis,clinical events,and influence of prolonged clopidogrel use after placement of drug-eluting stent:data from an observational cohort study of drug-eluting versus bare-metal stents.JACC Cardiovasc Interv,2008,1:494-503.
- [18]Pfistaer M,Brunner-La Rocca HP,Buser PT,et al.Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents:an observational study of drug-eluting versus bare-metal stents.J Am Coll Cardiol,2006,48:2584-2591.
- [19]Spertus JA,Kettelkamp R,Vance C,et al.Prevalence,predictors and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement:results from the PREMIER registry.Circulation,2006,113:2803-2809.