Mortality benefit with prasugrel in the TRITON-TIMI 38 coronary artery bypass grafting cohort: risk-adjusted retrospective data analysis.
Mortality benefit with prasugrel in the TRITON-TIMI 38 coronary artery bypass grafting cohort: risk-adjusted retrospective data analysis.
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DOI：
10.1016/j.jacc.2012.03.030
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发表时间：
2012-07-31
影响因子：
24
通讯作者：
LeNarz, LeRoy A.
中科院分区：
文献类型：
--
作者：
Smith, Peter K.;Goodnough, Lawrence T.;Levy, Jerrold H.;Poston, Robert S.;Short, Mary A.;Weerakkody, Govinda J.;LeNarz, LeRoy A.
本研究的目的是描述与冠状动脉旁路移植术（CABG）前普拉格雷或氯吡格雷停药时间相关的患者出血、输血和其他结局。对于可能需要紧急或紧急冠脉搭桥的患者，很少有证据可以指导临床决策使用普拉格雷。在使用氯吡格雷的情况下进行冠脉搭桥的经验引起了围手术期出血并发症的关注，这些并发症尚未解决。TRITON TIMI 38研究的一个子集，急性冠状动脉综合征患者随机接受阿司匹林和氯吡格雷或普拉格雷治疗，接受了孤立的冠脉搭桥（N=346）。设计并管理了补充病例报告表，并将数据与现有的TRITON-TIMI 38数据库相结合。使用欧洲心脏手术风险评估系统和胸外科学会预测算法校正基线不平衡。与氯吡格雷相比，普拉格雷的平均12小时胸管失血量（655±580 ml vs. 503±378 ml, p=0.050）显著高于氯吡格雷，红细胞输注（2.1单位vs. 1.7单位，p=0.442）或总供者暴露（4.4单位vs. 3.0单位，p=0.463）无显著差异。普拉格雷组的全因死亡率显著降低（2.31%），而氯吡格雷组为8.67%（校正优势比[OR]， 0.26, p=0.025）。尽管观察到出血、血小板输注和再次手术出血的发生率增加，但与氯吡格雷相比，普拉格雷与冠脉搭桥后死亡率较低相关。
The objective of this study is to characterize the bleeding, transfusion and other outcomes of patients related to the timing of prasugrel or clopidogrel withdrawal prior to coronary artery bypass grafting (CABG). There is little evidence to guide clinical decision making regarding the use of prasugrel in patients who may need urgent or emergency CABG. Experience with performing CABG in the presence of clopidogrel has raised concern about perioperative bleeding complications that are unresolved. A subset of the TRITON TIMI 38 study, where patients with acute coronary syndrome were randomized to treatment with aspirin and either clopidogrel or prasugrel, underwent isolated CABG (N=346). A supplemental case report form was designed and administered, and the data combined with the existing TRITON-TIMI 38 database. Baseline imbalances were corrected for using elements of the European System for Cardiac Operative Risk Evaluation and The Society of Thoracic Surgeons predictive algorithm. A significantly higher mean 12 hr chest tube blood loss (655±580 ml vs. 503±378 ml, p=0.050) was observed with prasugrel compared to clopidogrel, without significant differences in red blood cell transfusion (2.1 units vs. 1.7 units, p=0.442) or the total donor exposure (4.4 units vs. 3.0 units, p=0.463). All-cause mortality was significantly reduced with prasugrel (2.31%) compared to 8.67% with clopidogrel (adjusted odds ratio [OR], 0.26, p=0.025). Despite an increase in observed bleeding, platelet transfusion and surgical re-exploration for bleeding, prasugrel was associated with a lower rate of death following CABG compared to clopidogrel.
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影响因子：
3.4
作者：
Nashef, SAM;Rogues, F;Salamon, R
通讯作者：
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DOI：
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发表时间：
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通讯作者：
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作者：
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