置入国产雷帕霉素药物洗脱支架冠心病患者双联抗血小板治疗效果的研究

目的:对置入国产雷帕霉素支架(Firebird)的冠心病患者,12个月双联抗血小板(DAPT)后继续延长DAPT时间能否获益进行分析。方法:回顾性分析2007年1月至2009年12月,于北京安贞医院心内科置入Firebird支架的患者,按照DAPT的时间,分为12个月停用DAPT组和12个月DAPT组,通过门诊或电话随访,评价术后患者死亡、心肌梗死、脑卒中联合终点发生率,靶血管再次血运重建发生率。结果:共入选患者1 073例,随访平均(29.4±6.2)个月,按照排除标准筛选后共955例患者纳入分析,12个月停用DAPT患者410例,12个月DAPT组患者545例。12个月停用DAPT和12个月DAPT组死亡/心肌梗死/脑卒中发生率分别为5.2和1.6,P=0.016,多因素校正后,12个月停用DAPT组仍较12个月DAPT组显著增加死亡/心肌梗死/脑卒中风险(HR=3.56,95%CI:1.18~10.8,P=0.025)。结论:对于置入Firebird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显著降低不良事件风险。

Duration of dual antiplatelet therapy after implantation of firebird drug-eluting stent

Objective：To evaluate the potential benefit of prolonging 12-month dual antiplatelet therapy among patients with coronary artery disease receiving Firebird stent. Methods： From Jan. 2007 to Dec. 2009, patients with coronary artery disease undergoing PCI with Firebird stents in the cardiology department of Beijing Anzhen Hospital were enrolled. Our clinical endpoint focused on a composite of death, nonfatal myocardial infarction （MI） and stroke, and repeat revaseularization. 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 （ 29.4 ±6. 2）months. A toal of 955 appropriate patients were divided to two groups： 12-month DAPT group （n = 410） and 〉 12-month DAPT group （n = 545）. Rates of Death/MI/Stroke （5.2 vs. 1.6, P = 0. 016） were significantly higher with 12-month DAPT group compared with 〉 12-month DAPT group. After adjusted by the multi- variable Cox proportional-hazards regression, still significant higher rate of the endpoints mentioned above were observed with 12-month DAPT group. Conclusion： The use of dual antiplatelet therapy for a period longer than 12 months in patients who had received Firebird stents significantly reduced adverse cardiac or cerebrovaseular event compared with patients receiving only 12-month DAPT.