Short-term Safety and Mid-term Efficacy of Prasugrel Versus Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention
Short-term Safety and Mid-term Efficacy of Prasugrel Versus Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention
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DOI：
10.2169/internalmedicine.2262-18
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发表时间：
2019-01-01
影响因子：
1.2
通讯作者：
Inoue, Teruo
中科院分区：
文献类型：
--
作者：
Koyabu, Yota;Abe, Shichiro;Inoue, Teruo
目的虽然多项临床试验表明，经皮冠状动脉介入治疗（PCI）后，普拉格雷的中长期安全性和有效性优于氯吡格雷，但短期安全性方面的资料较少。方法回顾性分析250例连续行PCI并接受阿司匹林加普拉格雷治疗的冠心病患者（普拉格雷组，67.7±10.0岁，200名男性）的短期（72小时）PCI相关出血并发症和中期（12个月）疗效。对照组由250名年龄和性别匹配的患者组成，他们接受阿司匹林加氯吡格雷治疗（氯吡格雷组：67.2 +/- 11.2岁，199名男性）。结果prasugrel组pci术后急性期pci相关出血并发症发生率明显高于clopidogrel组（22.4% vs 13.2%, p =0.007），尽管两组在12个月内非pci相关出血并发症发生率相当。主要心血管事件（mace）的累积发生率在普拉格雷组和氯吡格雷组之间具有可比性（log-rank检验；p=0.561）。对250例接受普拉格雷治疗的患者进行多因素logistic回归分析显示，急性冠脉综合征与pci相关出血并发症的发生率呈负相关（p=0.061）。结论普拉格雷与氯吡格雷在pci后抗血小板方案中预防心血管事件的效果相似；然而，由于pci相关出血并发症的风险，应谨慎使用普拉格雷。
Objective Although several clinical trials have shown that the mid- and long-term safety and efficacy of prasugrel are better than those of clopidogrel after percutaneous coronary intervention (PCI), there are few data regarding the short-term safety.Methods In this study, we retrospectively analyzed the short-term (72 hours) PCI-related bleeding complications and mid-term (12 months) efficacy in 250 consecutive coronary artery disease patients who underwent PCI and received aspirin plus prasugrel (prasugrel group; 67.7 +/- 10.0 years, 200 men).Patients The comparison group consisted of 250 age- and gender-matched patients who received aspirin plus clopidogrel (clopidogrel group: 67.2 +/- 11.2 years, 199 men).Results The incidence of a composite of PCI-related bleeding complications in the acute phase post-PCI was significantly higher in the prasugrel group than in the clopidogrel group (22.4% vs. 13.2%, p =0.007), although the incidence of non-PCI-related bleeding complications over 12 months was comparable between the 2 groups. The cumulative incidence of major cardiovascular events (MACEs) was comparable between the prasugrel and clopidogrel groups (log-rank test; p=0.561). A multivariate logistic regression analysis of the 250 prasugrel-treated patients showed that acute coronary syndrome tended to be negatively associated with the incidence of PCI-related bleeding complications (p=0.061).Conclusion Prasugrel and clopidogrel may have similar efficacy for preventing cardiovascular events as the post-PCI antiplatelet regimen; however, prasugrel should be used cautiously because of the risk of PCI-related bleeding complications.