应用双联抗血小板治疗评分指导冠状动脉慢性闭塞病变患者抗血小板药物治疗

Dual antiplatelet therapy score-guided antiplatelet treatment in patients with coronary chronic total occlusion

摘要:

目的 探讨双联抗血小板治疗(DAPT)评分是否可用于指导冠状动脉慢性闭塞病变(CTO)患者经皮冠状动脉介入(PCI)术后的双联抗血小板药物治疗。方法 选取2014年1月至2017年6月于白求恩国际和平医院心血管内科接受PCI治疗的CTO患者497例,应用DAPT评分工具评估,分别观察≥2分及<2分的患者采用标准双联抗血小板治疗(12个月)或延长治疗(12～58个月)的主要心脑血管事件(MACCE)发生率及出血情况。采用SPSS 22.0软件进行数据统计分析。结果 共入组患者405例,随访时间34(28,44)个月。(1)在DAPT评分≥2分的患者中,延长双抗治疗组较标准双抗治疗组MACCE的发生率低,差异有统计学意义(5.5%和14.0%,P=0.040)。延长双抗治疗组心源性死亡、靶血管血运重建的发生率低于标准双抗治疗组,分别为(1.8％和8.6％,1.8％和8.6％),差异均有统计学意义(P<0.05)。Kaplan-Meier分析显示,延长双抗治疗组与标准双抗治疗组MACCE生存率比较,差异有统计学意义(P=0.046)。(2)在DAPT评分<2分的患者中,2组MACCE的比较,差异无统计学意义(P<0.05)。标准双抗治疗组的BARC 2,3,5型出血事件显著低于延长双抗治疗组(3.4％和12.8％,P=0.018)。Kaplan-Meier分析显示,标准双抗治疗组较延长双抗治疗组无出血事件生存率高(P=0.034)。结论 DAPT评分可用于指导CTO患者PCI术后双抗治疗的时程,≥2分的CTO患者PCI术后给予延长的双联抗血小板治疗获益更多,<2分的患者给予标准时程的双联抗血小板治疗出血风险更低。

Abstract:

Objective To validate the application of dual antiplatelet therapy (DAPT) score for the antiplatelet treatment in patients with coronary chronic total occlusion (CTO) after percutaneous coronary intervention (PCI). Methods A total of 497 patients with the consecutive CTO who underwent PCI in Bethune International Peace Hospital from January 2014 to June 2017 and then treated with DAPT for 12 months (the standard group) or prolonged to 12-58 months (the prolonged group)were enrolled in this study. The incidences of bleeding and major cardiovascular and cerebrovascular events (MACCE) were observed and compared between the patients with DAPT score ≥2points and <2points, and between those from the standard and prolonged groups. SPSS statistics 22.0 was used for data analysis. Results A total of 405 patients were enrolled in the final analysis, with follow-up period of 34 (28-44) months. (1) In the patients with DAPT score ≥2points, the incidence of MACCE was significantly lower in the prolonged group than in the standard group (5.5% vs 14.0%, P=0.040). The prolonged group had obviously lower rate of cardiac death (1.8% vs 8.6%, P=0.046) and incidence of target vessel revascularization (1.8% vs 8.6%, P=0.046) when compared with the standard group. Kaplan-Meier analysis showed that there was statistical difference in the MACCE-free survival rate between the prolonged and standard groups (P=0.046). (2) In the patients with a DAPT score <2points, there was no significant difference in the incidence of MACCE between the 2 groups. But the occurrence of Bleeding Academic Research Consortium (BARC) type 2,3,5 bleeding was significantly lower in the standard group than in the prolonged group (3.4% vs 12.8%, P=0.018). Kaplan-Meier analysis that indicated the standard group obtained notably higher bleeding-free survival rate than the other group (P=0.034). Conclusion DAPT score can be used to guide DAPT in CTO patients after PCI. The patients with the score ≥2points might benefit from prolonged DAPT, while for those with the score <2points, standard treatment should be carried out to decrease the risk of bleeding events.