Contemporary Antiplatelet Therapy and Clinical Outcomes of Japanese Patients With Acute Myocardial Infarction - Results From the Prospective Japan Acute Myocardial Infarction Registry (JAMIR).
Contemporary Antiplatelet Therapy and Clinical Outcomes of Japanese Patients With Acute Myocardial Infarction - Results From the Prospective Japan Acute Myocardial Infarction Registry (JAMIR).
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DOI：
10.1253/circj.cj-19-0145
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发表时间：
2019-07
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通讯作者：
S. Yasuda;S. Honda;M. Takegami;K. Nishihira;S. Kojima;Y. Asaumi;Makoto Suzuki;M. Kosuge;J. Takahashi;Y. Sakata;M. Takayama;T. Sumiyoshi;H. Ogawa;K. Kimura
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文献类型：
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作者：
S. Yasuda;S. Honda;M. Takegami;K. Nishihira;S. Kojima;Y. Asaumi;Makoto Suzuki;M. Kosuge;J. Takahashi;Y. Sakata;M. Takayama;T. Sumiyoshi;H. Ogawa;K. Kimura
背景抗血小板治疗是急性心肌梗死(AMI)治疗的基石。普拉格雷是一种新的有效的抗血小板药物，最近被引入临床实践。我们在日本的实际临床实践中比较了接受普拉格雷和氯吡格雷治疗的急性心肌梗死患者的临床结果。方法和结果：日本急性心肌梗死注册中心(JAMIR)是一个多中心的全国性前瞻性注册中心，登记了来自50个研究所的急性心肌梗死患者。2015年12月至2017年5月期间，共有3411名患者入选。其中，3069名患者在住院期间接受普拉格雷(n=2607)或氯吡格雷(n=462)治疗。中位随访期12个月。接受普拉格雷治疗的患者主要是男性，更年轻，更常出现ST段抬高的急性心肌梗死，并有较少的合并症。在使用相反的治疗加权概率进行调整后，主要终点，即心血管死亡、非致命性心肌梗死和非致命性中风的组合，在普拉格雷组和氯吡格雷组之间是相似的(调整后的风险比[HR]1.07，95%可信区间[CI]0.67-1.72)，而大出血(BARC 3型或5型出血)的风险在普拉格雷组显著降低(调整后的HR为0.62，95%CI为0.39-0.99)。结论JAMIR目前的真实数据库显示，有效的P2Y12抑制剂普拉格雷显示出与氯吡格雷相当的1年缺血事件发生率，但普拉格雷的出血风险低于氯吡格雷。
BACKGROUND Antiplatelet therapy is the corner stone of treatment following acute myocardial infarction (AMI). Prasugrel, a new and potent antiplatelet agent, was recently introduced to clinical practice. We compared the clinical outcomes of patients with AMI treated with prasugrel with those treated with clopidogrel in real-world clinical practice in Japan.Methods and Results:The Japan AMI Registry (JAMIR) is a multicenter, nationwide, prospective registry enrolling patients with AMI from 50 institutes. Between December 2015 and May 2017, a total of 3,411 patients were enrolled. Among them, 3,069 patients were treated with either prasugrel (n=2,607) or clopidogrel (n=462) during hospitalization. Median follow-up period was 12 months. Prasugrel-treated patients were predominantly male, younger, more often showed ST-elevation AMI, and had fewer comorbidities. After adjustment using inverse probability of treatment weighting, the primary endpoint, defined as a composite of cardiovascular death, non-fatal MI and non-fatal stroke, was comparable between the prasugrel and clopidogrel groups (adjusted hazard ratio [HR] 1.07, 95% confidence interval [CI] 0.67-1.72), whereas the risk of major bleeding (BARC type 3 or 5 bleeding) was significantly lower in the prasugrel group (adjusted HR 0.62, 95% CI 0.39-0.99). CONCLUSIONS The present real-world database of the JAMIR demonstrated that the potent P2Y12-inhibitor prasugrel showed comparable rates of 1-year ischemic events to clopidogrel, but the risk of bleeding was lower with prasugrel than with clopidogrel.