阿司匹林出院后维持剂量与急性心肌梗死(AMI)患者预后研究——TRANSLATE-ACS研究

   背景
   CURRENT-OASIS 7研究表明AMI患者30天后事件发生率,高剂量组阿司匹林(ASA)与低剂量组相比,无显著差异。后的AMI组之间没有差异。 但阿司匹林维持剂量对行PCI和双联抗血小板治疗的AMI患者长期预后情况的影响结果仍然不明确。
   方法
   纳入TRANSLATE-ACS观测研究中从2010年4月到2010年8月在209家美国医院住院且行PCI术的AMI患者6045例,出院后随机分为ASA低剂量组(<162mg/d)和高剂量组(≥162mg/d)。采用多变量Cox模型比较了两组在6个月的MACE风险(包括死亡、心肌梗死、卒中、或计划外血运重建的联合终点)和因出血事件再住院的风险。
   结果
  总共1808例(30%)出院时接受低剂量ASA,患者基线特征方面,与高剂量ASA组相比,低剂量ASA组年龄更高,既往有心肌梗死、卒中或 TIA,或糖尿病患者构成比更高。研究发现,与高剂量ASA组相比,低剂量ASA组STEMI发生率两者相似(50.0%对52.7%),但出院时接受裸金属支架(34.5%对26.9%,P <0.001)或第二代ADP抑制剂(普拉格雷或替卡格雷)(31.8%对27.7%,P = 0.001)比例较高,调整后协因子干扰后,6个月MACE率和出血事件发生率两者无显著差异。
   结论
   在美国,急性心梗PCI术后出院时处方低剂量ASA患者比例不到三分之一。研究发现,阿司匹林低剂量组与高剂量组相比,6个月时MACE率和出血风险无显著差异。

   英文原文
   The Association of Discharge Aspirin Dose and Outcomes in Acute Myocardial Infarction: Insights from the TRANSLATE-ACS Study

   Background
   CURRENT-OASIS 7 found no difference in 30-day outcomes between low and higher dose aspirin (ASA) groups post-AMI. The association of ASA dosing with long-term outcomes among contemporary AMI patients treated with PCI and dual antiplatelet therapy remains uncertain.
   Methods
   Use of low vs. higher dose (<162 mg vs. ≥162 mg daily) ASA at discharge was studied among 6,045 AMI patients treated with PCI at 209 U.S. hospitals in the TRANSLATE-ACS observational study from 4/2010-8/2012. We compared 6-month risks of MACE (composite of death, MI, stroke, or unplanned revascularization) and rehospitalization with bleeding between groups using multivariable Cox models.
   Results
   Overall, 1808 patients (30%) received low dose ASA at discharge. Patients prescribed low dose ASA were older, more often had prior MI, stroke/TIA, or diabetes. Compared with higher dose patients, those prescribed low dose ASA had similar rates of STEMI (50.0% vs. 52.7%), but were more likely toreceive bare metal stents (34.5% vs. 26.9%, p<0.001) or 2nd generation ADP inhibitors (prasugrel or ticagrelor) at discharge (31.8% vs. 27.7%, p=0.001). There were no significant differences in adjusted 6-month MACE and bleeding risks between patients discharged on low vs. higher dose ASA (Table).
   Conclusion
   Low dose ASA is prescribed at discharge in less than one-third of PCI-treated AMI patients in the U.S. There was no significant difference in 6-month risks of cardiovascular events and bleeding between dosing 。


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2013/3/12 14:10:27
李建民:谢谢,拜读了。
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