冠心病介入术后双联抗血小板治疗持续时间的研究

目的:对置入佐他莫司洗脱支架的冠心病患者双联抗血小板治疗(DAPT)12个月后,继续延长治疗时间能否获益进行分析。方法:回顾性分析2006年9月至2009年6月于北京安贞医院心内科置入佐他莫司洗脱支架的患者,按照DAPT的时间分为:DAPT12个月组和DAPT>12个月组,通过门诊或电话随访,评价术后患者主要不良心脑血管病事件(死亡、心肌梗死、卒中和靶血管再次血运重建发生率),观察两组患者以上各终点差异是否有统计学意义。结果:随访平均(28.4±7.4)个月,共915例患者纳入分析,DAPT 12个月组362例,DAPT>12个月组553例。两组主要心血管事件(MACCE)发生率分别为3.6%和4.3%,Log rank P=0.87血运重建(TVR)分别为2.2%和2.5%,Log rank P=0.97,死亡、心肌梗死、卒中各终点两组间差异均无统计学意义。结论:对于置入佐他莫司洗脱支架的患者,与12个月时停用DAPT仅使用阿司匹林比较,12个月后继续使用DAPT未能显示出优势,两者无明显差异,12个月时停用氯吡格雷安全有效。

Duration of dual antiplatelet therapy after implantation of drug-eluting stents

Objective:To evaluate the potential benefit of prolonging 12-month dual antiplatelet therapy among patients with coronary artery disease receiving zotarolimus-eluting stents.Methods:From Sep.2006 to Jue.2009,patients with coronary artery disease undergoing PCI with zotarolimus-eluting stents in the cardiology department of Beijing Anzhen Hospital were enrolled.Our clinical endpoint focused on major adverse cardiac or cerebrovascular events(MACCE),death,nonfatal myocardial infarction(MI),stroke,and repeat revascularization.Follow up was carried out by telephone or outpatient interview.To overcome the defect of non-randomized comparisons,multivariable Cox proportional-hazards regression was carried out to adjust for potential confounding factors.Results:The average follow-up was(28.4±7.4) months.A toal of 915 appropriate patients were divided to two groups: 12-month DAPT group(362) and >12-month DAPT group(553).Rates of MACCE(3.6% VS.4.3%,P=0.87) and TVR(2.2% VS.2.5%,P=0.97) did not differ between 12-month DAPT group and >12-month DAPT group.After adjusted by the multivariable Cox proportional-hazards regression,still no significant differences of the endpoints mentioned above were observed between the two groups.Rates of death MI or stroke were not significantly different between the two groups either.Conclusion:The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received zotarolimus-eluting stents was not significantly more effective than aspirin monotherapy in reducing adverse cardiac or cerebrovascular event.