作者：王蓉，胡东南，王进，陆蕙，付坤

单位：

100076北京市，北京航天总医院心血管内科 通信作者：王蓉，E-mail：mirgl78@126.com

Units：

Department of Cardiovascular Medicine, Beijing Aerospace General Hospital, Beijing 100076, China Corresponding author: WANG Rong, E-mail: mirgl78@126.com

关键词：

急性冠脉综合征; 经皮冠状动脉介入治疗; 双重抗血小板治疗; 心脑血管不良事件; 出血事件;

Keywords：

Acute coronary syndrome; Percutaneous coronary intervention; Dual anti-platelet therapy; Cardiovascularand cerebrovascular adverse events; Bleeding events

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.171

Funds：

北京航天总医院创新基金项目（2018-509）

摘要：

目的 分析双重抗血小板治疗(DAPT)转换在PCI后发生血小板高反应性(HPR)的急性冠脉综合征(ACS)患者中的应用效果及其最佳时间。方法 选取2019年2月至2020年11月北京航天总医院收治的PCI后接受DAPT的ACS患者270例,采用掷骰子法将其分为A、B、C组,各90例,其分别于强化DAPT方案(阿司匹林+替格瑞洛)治疗2周、1个月、3个月时进入药物洗脱期[采用标准DAPT方案(阿司匹林+氯吡格雷)治疗1周],然后选取发生HPR的患者103例(A组48例,B组35例,C组20例)为研究对象,再次采用掷骰子法将其分别分为A转换亚组(采用标准DAPT方案治疗,24例)和A不转换亚组(继续采用强化DAPT方案治疗,24例)、B转换亚组(采用标准DAPT方案治疗,17例)和B不转换亚组(继续采用强化DAPT方案治疗,18例)、C转换亚组(采用标准DAPT方案治疗,10例)和C不转换亚组(继续采用强化DAPT方案治疗,10例)。所有患者连续治疗1年。收集患者一般资料,比较A转换亚组与A不转换亚组、B转换亚组与B不转换亚组、C转换亚组与C不转换亚组心脑血管不良事件、出血事件发生率,比较A、B、C转换亚组心脑血管不良事件发生率。结果 A转换亚组心脑血管不良事件发生率低于A不转换亚组(P<0.05);A转换亚组与A不转换亚组出血事件发生率比较,差异无统计学意义(P>0.05)。B转换亚组与B不转换亚组心脑血管不良事件、出血事件发生率比较,差异无统计学意义(P>0.05)。C转换亚组与C不转换亚组心脑血管不良事件、出血事件发生率比较,差异无统计学意义(P>0.05)。A转换亚组心脑血管不良事件发生率高于B转化亚组(P<0.05);A转换亚组与C转化亚组心脑血管不良事件发生率比较,差异无统计学意义(P>0.05);B转换亚组与C转化亚组心脑血管不良事件发生率比较,差异无统计学意义(P>0.05)。结论 DAPT转换策略可能会降低PCI后发生HPR的ACS患者心脑血管不良事件发生风险,且不会增加出血事件发生风险,具有较高的临床应用价值;且DAPT转换的最佳时间为强化DAPT方案治疗1个月。

Abstract：

【Abstract】　Objective To analyze the effect and optimal time of dual antiplatelet therapy (DAPT) conversion in acutecoronary syndrome (ACS) patients with high on-treatment platelet reactivity (HPR) after PCI. Methods A total of 270 patientswith ACS treated with DAPT after PCI in Beijing Aerospace General Hospital from February 2019 to November 2020 wereselected, and they were divided into group A, group B and group C according to throwing dice method, with 90 cases in each group.They entered the drug elution period [treated with standard DAPT regimen (aspirin+clopidogrel) for 1 week] after 2 weeks, 1 monthand 3 months of intensive DAPT regimen (aspirin+ticagrelor) respectively, then 103 patients with HPR (48 cases in group A, 35cases in group B and 20 cases in group C) were selected as the research subjects. They were divided into A conversion subgroup(treated with standard DAPT regimen, n=24) and A non conversion subgroup (continued to be treated with intensive DAPTregimen, n=24) , B conversion subgroup (treated with standard DAPT regimen, n=17) and B non conversion subgroup (continuedto be treated with intensive DAPT regimen, n=18) , C conversion subgroup (treated with standard DAPT regimen,n=10) and Cnon conversion subgroup (continued to be treated with intensive DAPT regimen,n=10) according to throwing dice method. Allpatients were treated continuously for 1 year. The general data of patients were collected, and the incidence of cardiovascular andcerebrovascular adverse events and bleeding events between A conversion subgroup and A non conversion subgroup, B conversionsubgroup and B non conversion subgroup, C conversion subgroup and C non conversion subgroup were compared. The incidenceof cardiovascular and cerebrovascular adverse events was compared in A, B, and C conversion subgroups. Results The incidenceof cardiovascular and cerebrovascular adverse events in A conversion subgroup was lower than that in A non conversion subgroup (P<0.05) ; there was no statistical significant difference in the incidence of bleeding events between A conversion subgroup and Anon conversion subgroup (P >0.05) . There was no statistical significant difference in the incidence of adverse cardiovascular andcerebrovascular events and bleeding events between B conversion subgroup and B non conversion subgroup (P >0.05) . There was nostatistical significant difference in the incidence of cardiovascular and cerebrovascular adverse events and bleeding events between Cconversion subgroup and C non conversion subgroup (P >0.05) . The incidence of cardiovascular and cerebrovascular adverse eventsin A conversion subgroup was higher than that in B conversion subgroup (P <0.05) ; there was no statistical significant difference inthe incidence of cardiovascular and cerebrovascular adverse events between A conversion subgroup and C conversion subgroup (P >0.05) ; there was no statistical significant difference in the incidence of cardiovascular and cerebrovascular adverse events betweenB conversion subgroup and C conversion subgroup (P >0.05) .Conclusion DAPT conversion strategy may reduce the risk ofcardiovascular and cerebrovascular adverse events in ACS patients with HPR after PCI, and will not increase the risk of bleedingevents, which has high clinical application value; and the best time of DAPT conversion is at 1 month of intensive DAPT regimentreatment.

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