Incidence and outcome of switching of oral platelet P2Y12 receptor inhibitors in patients with acute coronary syndromes undergoing percutaneous coronary intervention: the SCOPE registry
Incidence and outcome of switching of oral platelet P2Y12 receptor inhibitors in patients with acute coronary syndromes undergoing percutaneous coronary intervention: the SCOPE registry
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DOI：
10.4244/eij-d-17-00092
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发表时间：
2017-07-01
期刊：
影响因子：
6.2
通讯作者：
Bolognese, Leonardo
中科院分区：
文献类型：
--
作者：
De Luca, Leonardo;D' Ascenzo, Fabrizio;Bolognese, Leonardo
目的：在接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者中，可能经常更换口服P2Y（12）受体抑制剂。我们的目的是评估三个月内连续接受 PCI 的 ACS 患者目前更换口服 P2Y(12) 受体抑制剂的发生率及其安全性。方法和结果：SCOPE 登记是一项多中心、观察性、前瞻性研究。意大利 39 个 PCI 中心共有 1,363 名连续患者入组。导管实验室中 2.3%、出院时 3.3% 和随访时 5.1% 发生口服抗血小板治疗转换。主要不良脑血管事件（MACE）和净不良脑血管事件（NACE：MACE和出血事件的组合）的累积发生率分别为1.6%和5.6%。在接受升级转换（从旧的 P2Y(12) 受体抑制剂改为新型 P2Y(12) 受体抑制剂）的患者中，在整个研究期间没有发生缺血或出血事件。另一方面，降级转换（从新型 P2Y(12) 受体抑制剂改为旧式 P2Y(12) 受体抑制剂）是 NACE 的独立预测因素（OR 5.3；CI：2.1-18.2；p=0.04）。 结论：在接受 PCI 的 ACS 患者中，转换口服抗血小板治疗并不罕见。值得注意的是，从氯吡格雷转换为新型 P2Y(12) 受体抑制剂似乎是安全的，而在早期阶段进行降级转换似乎是安全的。 ACS 与不良临床事件相关。
Aims: In patients with acute coronary syndromes (ACS) undergoing a percutaneous coronary intervention (PCI), switching of oral P2Y(12) receptor inhibitors may frequently occur. We aimed to assess the current incidence of switching of oral P2Y(12) receptor inhibitors and its safety in consecutive ACS patients undergoing PCI over a three-month period.Methods and results: The SCOPE registry was a multicentre, observational, prospective study. A total of 1,363 consecutive patients were enrolled in 39 PCI centres across Italy. Switching of oral antiplatelet therapies occurred in 2.3% in the cathlab, 3.3% at discharge and 5.1% at follow-up. The cumulative incidence of major adverse cerebrovascular events (MACE) and net adverse cerebrovascular events (NACE: a combination of MACE and bleeding events) was 1.6% and 5.6%, respectively. Among patients receiving an upgrade switching (change from old to novel P2Y(12) receptor inhibitors), no ischaemic or bleeding events occurred during the whole study period. On the other hand, downgrade switching (from novel to old P2Y(12) receptor inhibitors) was an independent predictor of NACE (OR 5.3; CI: 2.1-18.2; p=0.04).Conclusions: Switching of oral antiplatelet therapies is not uncommon among ACS patients undergoing PCI Notably, switching from clopidogrel to novel P2Y(12) receptor inhibitors appears safe, while a downgrade switching in early phases of ACS is associated with adverse clinical events.