Premature Discontinuation of Dual Antiplatelet Therapy After Coronary Stenting in Veterans: Characteristics and Long-Term Outcomes.
Premature Discontinuation of Dual Antiplatelet Therapy After Coronary Stenting in Veterans: Characteristics and Long-Term Outcomes.
复制标题
退伍军人冠状动脉支架置入术后过早停止双联抗血小板治疗：特征和长期结果。
DOI：
10.1161/jaha.120.018481
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发表时间：
2021-05-04
影响因子：
5.4
通讯作者：
Gagnon D
中科院分区：
文献类型：
--
作者：
Kinlay S;Quach L;Cormack J;Morgenstern N;Hou Y;Young M;Sherrod R;Cho K;Faxon DP;Ramadan R;Gaziano M;Gagnon D
经皮冠状动脉介入治疗后过早停止双联抗血小板治疗（DAPT）与不良结局的短期风险较高相关。这些风险是否长期存在尚不确定。我们评估了2006年至2012年期间在退伍军人事务部医疗保健系统中使用冠状动脉第二代或第一代药物洗脱支架进行经皮冠状动脉介入治疗的所有患者，这些患者在前12个月内没有发生严重缺血或出血事件。通过多变量logistic模型的比值比（OR）评估了提前停止DAPT（持续时间1-9个月）、>9 - 12个月或延长持续时间（>12个月）的患者的特征。通过考克斯回归模型的风险比（HR）和95% CI评估了提前停止DAPT的患者在平均5.1年内的不良临床结局风险。共有14239例植入了第二代药物洗脱支架，8583例植入了第一代药物洗脱支架。黑人患者（OR，1.54; 95% CI，1.40-1.68）、更虚弱患者（OR，1.04; 95% CI，1.03-1.05）和低密度脂蛋白胆固醇较高患者更可能提前停用DAPT，接受他汀类药物治疗的患者不太可能提前停用DAPT（OR，0.87; 95% CI，0.80-0.95）。提前停止DAPT的患者的长期死亡风险较高（第二代药物洗脱支架：HR，1.35; 95% CI，1.19-1.56），心肌梗死（第二代药物洗脱支架：HR，1.46; 95%CI，1.22-1.74）和重复冠状动脉血运重建（第二代药物洗脱支架：HR，1.24; 95% CI，1.08-1.41）。过早停止DAPT的患者具有反映更大虚弱、更差药物使用和其他社会因素的特征。长期来看，他们的主要不良结局风险仍然较高，在经皮冠状动脉介入治疗多年后可能需要更密集的监测。
Premature discontinuation of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is related to higher short‐term risks of adverse outcomes. Whether these risks persist in the long‐term is uncertain. We assessed all patients having percutaneous coronary intervention with coronary second‐ or first‐generation drug‐eluting stents in the Veterans Affairs healthcare system between 2006 and 2012 who were free of major ischemic or bleeding events in the first 12 months. The characteristics of patients who stopped DAPT prematurely (1–9 months duration), compared with >9 to 12 months, or extended duration (>12 months) were assessed by odds ratios (ORs) from multivariable logistic models. The risk of adverse clinical outcomes over a mean 5.1 years in patients who stopped DAPT prematurely was assessed by hazard ratios (HRs) and 95% CIs from Cox regression models. A total of 14 239 had second‐generation drug‐eluting stents, and 8583 had first‐generation drug‐eluting stents. Premature discontinuation of DAPT was more likely in Black patients (OR, 1.54; 95% CI, 1.40–1.68), patients with greater frailty (OR, 1.04; 95% CI, 1.03–1.05), and patients with higher low‐density lipoprotein cholesterol, and less likely in patients on statins (OR, 0.87; 95% CI, 0.80–0.95). Patients who stopped DAPT prematurely had higher long‐term risks of death (second‐generation drug‐eluting stents: HR, 1.35; 95% CI, 1.19–1.56), myocardial infarction (second‐generation drug‐eluting stents: HR, 1.46; 95% CI, 1.22–1.74), and repeated coronary revascularization (second‐generation drug‐eluting stents: HR, 1.24; 95% CI, 1.08–1.41). Patients who stop DAPT prematurely have features that reflect greater frailty, poorer medication use, and other social factors. They continue to have higher risks of major adverse outcomes over the long‐term and may require more intensive surveillance many years after percutaneous coronary intervention.