陆文彬,陈立娟,鞠成伟,朱建,傅聪,姚玉宇,马根山

• 1:东南大学附属中大医院心内科

摘要(Abstract)：

目的比较心房颤动(AF)患者冠状动脉支架置入术后三联抗栓(华法林+阿司匹林+氯吡格雷)及二联抗栓(华法林+氯吡格雷)治疗的出血和不良心血管事件发生率。方法收集2007年6月至2012年6月入住东南大学附属中大医院心内科行冠状动脉支架置入术的AF患者228例,根据患者术后的抗栓方案分为三联抗栓治疗组(TT组,120例)和二联抗栓治疗组(DT组,108例),两组AF患者均在冠状动脉支架置入术后6~12 h内开始行不同的抗栓治疗方案。采用MantelCox检验和Kaplan-Meier生存曲线比较两组患者出血事件及不良心血管事件的发生率,并进行因素分析。结果 90 d内TT组总出血事件发生率显著高于DT组(18.3%比6.5%,P=0.007),高HASBLED评分(HR 5.74,95%CI 2.53~12.99,P<0.001)、三支血管病变(HR 4.27,95%CI 1.00~18.20,P=0.05)均与患者的早期出血事件显著相关。90~360 d TT组总出血事件发生率仍高于DT组(24.2%比11.1%,P=0.010)。早期随访期间出血(HR 2.818,95%CI 1.40~5.66,P=0.004)、血小板糖蛋白Ⅱb/Ⅲa抑制剂的使用(HR 5.87,95%CI 2.16~15.96,P=0.001)、高HAS-BLED评分(HR 2.07,95%CI 1.06~4.06,P=0.034)均与晚期出血事件显著相关。TT组和DT组主要不良心血管事件的发生率比较,差异无统计学意义(7.5%比10.2%,P=0.474)。缺血及卒中史(HR 3.27,95%CI 1.15~9.31,P=0.026)、高CHA2DS2-VASc评分(HR 4.85,95%CI 1.08~21.90,P=0.04)、心力衰竭(HR 3.9,95%CI 1.41~10.81,P=0.009)均与主要不良心血管事件显著相关。结论 AF患者冠状动脉支架置入术后行三联抗栓治疗显著增加总出血事件发生率。HAS-BLED以及CHA2DS2-VASc评分等出血及血栓风险的评估对冠状动脉支架置入术后AF患者抗栓治疗方案的选择至关重要。

关键词(KeyWords)： 心房颤动;冠心病;抗栓治疗;出血;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 陆文彬,陈立娟,鞠成伟,朱建,傅聪,姚玉宇,马根山

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