老年急性冠脉综合征或经皮冠状动脉介入术后患者应用替格瑞洛早期停药对临床转归的影响

Impact of early ticagrelor discontinuation on clinical outcomes in the elderly patients with acute coronary syndrome or after percutaneous coronary intervention

摘要:

目的 探讨≥75岁急性冠脉综合征(ACS)或经皮冠状动脉介入(PCI)支架植入术后患者应用替格瑞洛早期停药对临床转归的影响。方法 连续募集2014年1月至2016年5月在解放军总医院心血管内科住院期间接受替格瑞洛联合阿司匹林双联抗血小板治疗的≥75岁ACS或PCI支架植入术后患者。分析患者早期(服用3个月内)替格瑞洛停用发生情况、停药原因及停药对患者1年内发生主要缺血终点事件(心源性死亡、非致死性心肌梗死、非致死性脑卒中、紧急血运重建、早期支架内血栓形成、晚期支架内血栓形成)及主要出血终点事件(出血学术研究联合会≥3型)的影响。结果 本研究共募集190例符合入选标准的病例,年龄(78.7±3.6)岁,其中65例(占34.2%)患者早期停用替格瑞洛。早期停药患者1年内主要缺血终点事件的发生率显著高于持续替格瑞洛治疗患者(13.8% vs 5.7%；HR=3.57,95%CI 1.15～11.09；P=0.03)。1年内主要出血终点事件在早期停药患者与持续替格瑞洛治疗患者之间差异无统计学意义(1.5% vs 2.4%；HR=0.57,95%CI 0.05～6.00；P=0.64)。结论 老年(≥75岁)ACS或PCI术后患者早期(3个月内)停用替格瑞洛可能增加主要缺血事件发生风险。

Abstract:

Objective The present study aimed to investigate the impact of early ticagrelor discontinuation (ETD) on clinical outcomes in the elderly patients (≥75) with acute coronary syndrome (ACS) or after percutaneous coronary intervention (PCI). Methods Recruited in the study were consecutive patients with ACS or after PCI treated with ticagrelor and aspirin in the Department of Cardiology of the Chinese PLA General Hospital from January 2014 to May 2016. The incidence and the reasons for ETD were recorded. Analysis was made of ETD (with 3 months of use), its reasons, and its influence on major ischemic events (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, emergency revascularization, early stent thrombosis, late stent thrombosis) and major bleeding events [Bleeding Academic Research Consortium (BARC)≥ type 3] during a 1-year period. Results A total of 190 eligible elderly patients were recruited [age(78.7±3.6) years], of whom 65 (34.2%) discontinued ticagrelor early. Within a 12-month follow-up, the incidence of major ischemic events was significantly higher in the ETD patients than in those with continued ticagrelor treatment (13.8% vs 5.7%; HR=3.57,5%CI 1.15-11.09; P=0.03). No significant difference was found for the major bleeding events (1.5% vs 2.4%; HR=0.57,5%CI 0.05-6.00; P=0.64). Conclusion ETD within 3 months of medication in the elderly patients (≥75) with ACS or after PCI might increase the risk of major ischemic events.