摘要
目的探讨老年急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)3个月后应用小剂量替格瑞洛的安全性和有效性。方法单中心回顾性队列研究。连续入选2017年11月至2019年10月在首都医科大学附属北京安贞医院行PCI术后双联抗血小板治疗3个月内无主要不良心血管事件及大出血事件的老年(≥65岁)ACS患者596例。根据PCI术3个月后抗血小板治疗策略的不同分为两组:阿司匹林100 mg/d联合标准剂量替格瑞洛(90 mg/次,2次/d)496例或联合小剂量替格瑞洛(45 mg/次,2次/d)100例。又利用倾向性评分匹配得出,基线无统计学差异的标准剂量替格瑞洛组192例和小剂量替格瑞洛组99例。比较两组患者分组后随访9个月的不良心血管事件及出血事件的发生率。采用多因素Cox比例风险回归模型分析出血事件的影响因素。结果匹配后,两组患者的年龄、性别、体质指数、心血管危险因素、其他病史、病变及手术特征、合并用药等方面比较,差异均无统计学意义(均为P>0.05)。匹配前,与标准剂量替格瑞洛组相比,小剂量替格瑞洛组BARC所有出血及BARC 1型出血均明显下降(均为P<0.01),BARC 2型出血仅有降低趋势(P=0.06)。匹配后,小剂量替格瑞洛组上述所有出血事件均明显低于标准剂量替格瑞洛组(均为P<0.05)。无论匹配前后,两组BARC 3或5型出血及主要不良心血管事件的发生率差异均无统计学意义(均为P>0.01)。Cox回归分析显示,年龄、标准剂量替格瑞洛和左心室射血分数下降是出血事件的独立危险因素(均为P<0.01)。结论在接受PCI治疗的老年ACS患者中,小剂量替格瑞洛降低了轻中度出血的风险,同时未增加不良心血管事件的发生率。
Objective To investigate the safety and efficacy of low-dose ticagrelor in elderly patients with acute coronary syndrome(ACS)3 months after percutaneous coronary intervention(PCI).Methods In the single center retrospective cohort study,a total of 596 elderly ACS patients(≥65 years old)who received dual antiplatelet therapy and without major adverse cardiovascular events(MACE)and major bleeding events within 3 months after PCI in Beijing Anzhen Hospital from November 2017 to October 2019 were enrolled.According to the anti-platelet strategies 3 months after PCI,the patients were divided into 2 groups:aspirin 100 mg/d combined with standard-dose ticagrelor(90 mg twice daily)496 cases or combined with low-dose ticagrelor(45 mg twice daily)100 cases.By using propensity score matching,standard-dose ticagrelor group(n=192)or low-dose ticagrelor group(n=99)had no significant difference in baseline.The incidences of MACE and bleeding events were compared between the two groups during 9 months follow-up.At the same time,multivariate Cox regression proportional hazard regression model was used to analyze the influencing factors of bleeding events.Results After matching,there were no significant differences in age,gender,body mass index,cardiovascular risk factors,other medical history,pathological changes and surgical characteristics,and medication between the two groups(all P>0.05).Before matching,compared with the standard-dose ticagrelor group,all bleeding events and BARC type 1 bleeding events in the low-dose ticagrelor group significantly decreased(all P<0.01),and BARC type 2 bleeding events only showed a downward trend(P=0.06).After matching,all the above bleeding events were significantly lower in the low-dose ticagrelor group than in the standard-dose ticagrelor group(all P<0.05).The incidences of BARC type 3 or 5 bleeding events and MACE between the two groups before and after matching were not different(all P>0.05).Cox regression analysis showed that age,standard-dose ticagrelor and decreased left ventricular ejection fraction were the independent risk factors of bleeding events(all P<0.01).Conclusions Low-dose ticagrelor may reduce the risk of mild to moderate bleeding and may not increase the incidence of adverse cardiovascular events in elderly patients with ACS undergoing PCI.
作者
李文铮
王悦
刘倍倍
陈蕾蕾
王越
田磊
李果
张宇晨
吴小凡
Li Wenzheng;Wang Yue;Liu Beibei;Chen Leilei;Wang Yue;Tian Lei;Li Guo;Zhang Yuchen;Wu Xiaofan(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中国心血管杂志》
2022年第3期222-228,共7页
Chinese Journal of Cardiovascular Medicine
基金
首都卫生发展科研专项(首发2018-2-2064)
国家自然科学基金(82071573)
北京市教育委员会科技计划重点项目(KZ202010025045)。
