Association of Antiplatelet Therapy, Including Cilostazol, With Improved Survival in Patients With Moyamoya Disease in a Nationwide Study.
Association of Antiplatelet Therapy, Including Cilostazol, With Improved Survival in Patients With Moyamoya Disease in a Nationwide Study.
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DOI：
10.1161/jaha.120.017701
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发表时间：
2021-03
影响因子：
5.4
通讯作者：
Kim GM
中科院分区：
文献类型：
--
作者：
Seo WK;Kim JY;Choi EH;Kim YS;Chung JW;Saver JL;Bang OY;Kim GM
尽管在常规临床实践中，抗血小板药物经常用于烟雾病，但尚无大规模流行病学试验或随机试验证据支持其在烟雾病患者中的应用。使用韩国国家健康保险服务数据库，对2002至2016年间被诊断为烟雾病的患者进行了长达14年的跟踪调查，在所有患者中使用时间依赖的Cox回归，并在倾向分数匹配的队列中评估抗血小板治疗和个别抗血小板药物与生存率的关系。新诊断的烟雾病患者25例，平均年龄37.6±19.9岁，女性占61.6%，总随访163/347人年。在9154名在随访期内至少服用一次抗血小板药物的患者中，西洛他唑的处方比例从2002年的5.5%逐渐上升到2016年的56.0%。在多变量模型中，任何抗血小板药物的使用都与死亡风险降低有关(风险比为0.77；95%可信区间为0.70-0.84)。在单独的抗血小板药物中，西洛他唑与其他5种抗血小板药物相比死亡率的降低更大。根据年龄组和缺血性卒中病史进行亚组分析，并采用倾向得分匹配分析进行敏感度分析，结果一致。抗血小板治疗与烟雾病患者存活率的显著提高有关，与其他抗血小板方案相比，西洛他唑可带来更大的存活率收益。这些结果暂时支持在烟雾病患者中使用抗血小板治疗和进行验证性随机对照试验。
Although antiplatelet agents are frequently prescribed in moyamoya disease in routine clinical practice, there are no large‐scale epidemiologic trials or randomized trial evidence to support their use in patients with moyamoya disease. Using the Korean National Health Insurance Service database, patients diagnosed with moyamoya disease between 2002 and 2016 were followed up for up to 14 years to assess, using time‐dependent Cox regression in all patients and in a propensity score–matched cohort, the association of antiplatelet therapy and individual antiplatelet agents with survival. Among 25 978 patients with newly diagnosed moyamoya disease, mean age was 37.6±19.9 years, 61.6% were women, and total follow‐up was 163 347 person‐years. Among 9154 patients who were prescribed antiplatelet agents at least once during the follow‐up period, the proportion prescribed cilostazol gradually increased from 5.5% in 2002 to 56.0% in 2016. Any antiplatelet use was associated with reduced risk of death (hazard ratio, 0.77; 95% CI, 0.70–0.84) in a multivariate model. Among individual antiplatelet agents, cilostazol was associated with greater reduction in mortality than the 5 other antiplatelet regimens. Subgroup analysis, according to the age group and history of ischemic stroke, and sensitivity analysis, using propensity score–matched analysis, revealed consistent results. Antiplatelet therapy is associated with substantial improvement in survival in patients with moyamoya disease, and cilostazol is associated with greater survival benefit compared with other antiplatelet regimens. These results provisionally support the use of antiplatelet therapy in patients with moyamoya disease and the conduct of confirmatory randomized controlled trials.