目的 探讨合并心房纤颤的急性冠脉综合征(acute coronary syndrome,ACS)患者支架置入术后不同抗栓方案的有效性和安全性。方法 选择因ACS入院行经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)的1674例患者,根据是否合并心房纤颤分为并发心房纤颤组(78例)和无心房纤颤组(1596例)进行对比分析;同时在并发心房纤颤组中选择置入支架的54例卒中高危 (CHA2DS2-VASc≥2分)患者随访1年,根据是否使用华法林分为华法林组(n=19)及非华法林组(n=35)。统计各组全因死亡、大出血及小出血事件的发生率。结果 并发心房纤颤组较无心房纤颤组三支病变的比例增高,住院期间全因死亡明显增加(12.8% vs 1.8%,P0.01)。卒中高危患者中,华法林组质子泵抑制药(PPI)应用比例显著高于非华法林组(100% vs 51.7%,P0.001),两组均无缺血性脑卒中短暂性脑缺血发作、非致死性心肌梗死等事件发生。华法林组轻微出血发生率高于非华法林组(21.1% vs 2.9%, P=0.028)。结论 合并心房纤颤的ACS患者支架置入术后应用6个月三联抗栓治疗,在积极使用PPI的情况下,可能具有较好的有效性和安全性,但是会增加轻微出血的发生率。
Abstract
Objective To compare the efficacy and safety of different antithrombotic therapies in patients after coronary stent implantation through follow-up.Methods The cross-sectional observation study enrolled 1674 ACS patients who had undergone PCI in our hospital. According complications with (n=78) or without (n=1596) atrial fibrillation, these patients were divided into two groups and their clinical manifestations were compared. We followed up 54 patients with CHA2DS2-VASc≥2 in the group combined with atrial fibrillation for one year. According to the antithrombotic regimens, these patients were divided into warfarin group(n=19) or non-warfarin group(n=35). SPSS 19.0 was used for statistical analysis.Results The rate of triple vessel lesion was higher in the group combined with atrial fibrillation, and the incidence of death during the in-hospital period(12.8% vs 1.8%, P0.001) was significantly higher than in the group without atrial fibrillation. During the follow-up, significantly more proton pump inhibitors (PPIs) were used in warfarin group than in non-warfarin group (100% vs 51.7%, P0.001). The incidence of minimal bleeding in warfarin group was higher than in non-warfarin group (21.1% vs 2.9%, P=0.028).Conclusions Triple antithrombotic therapy is recommended for patients with ACS after coronary stent implantation. Proper use of PPI may achieve good efficacy and safety.
关键词
心房纤颤 /
急性冠脉综合征 /
冠状动脉支架置入术 /
抗栓治疗 /
出血
Key words
atrial fibrillation /
acute coronary syndrome /
coronary stent implantation /
antithrombotic therapy /
bleeding
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参考文献
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