Effects of aspirin and trapidil on cardiovascular events after acute myocardial infarction
Effects of aspirin and trapidil on cardiovascular events after acute myocardial infarction
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DOI：
10.1016/s0002-9149(99)00091-0
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发表时间：
1999-05-01
影响因子：
2.8
通讯作者：
Tamura, Y
中科院分区：
文献类型：
--
作者：
Yasue, H;Ogawa, H;Tamura, Y
阿司匹林治疗在发展中的心肌梗塞的急性期具有决定性的净益处，但在任何一项研究中都没有明确的证据表明急性心肌梗塞（AMI）后长期使用阿司匹林有益处。这项多中心研究，即日本抗血小板心肌梗死研究，旨在查明梗塞后患者中阿司匹林或曲匹地尔与不服用抗血小板药物相比是否会改善临床结果。该研究是一项多中心、开放标签、随机对照试验，对症状出现后 1 个月内入院的 AMI 患者进行阿司匹林 81 毫克/天、曲匹地尔 300 毫克/天，不服用抗血小板药物，入组 723 名患者。日本18个都道府县的70家医院； 250 名患者被随机分配接受 81 mg 阿司匹林治疗（阿司匹林组），243 名患者接受曲匹地尔治疗（曲匹地尔组），230 名患者不接受抗血小板药物治疗。平均随访期为 475 天。这项研究表明，与 AMI 后未接受抗血小板治疗的组相比，长期服用 81 mg/天剂量的阿司匹林可降低复发 AMI 的发生率 (p = 0.0045)，与未接受抗血小板治疗的组相比，曲匹地也减少了再梗死的发生，但差异不显着 (p = 0.0810)。与未接受抗血小板治疗的患者相比，每天接受 300 mg 曲匹地尔治疗的患者中非致命性缺血性卒中的发生率有所降低 (p = 0.0039)。在心血管事件发生率方面，每天使用 81 mg 曲匹地尔与不使用抗血小板治疗相比几乎没有任何益处。总而言之，长期使用低剂量阿司匹林 (81 mg) 可有效预防梗死后患者在溶栓或冠状动脉成形术后复发 AMI。此外，长期使用曲匹地尔可显着降低心血管事件的发生率，(C) 1999，Excerpta Medica, Inc.
Aspirin therapy confers conclusive net benefits in the acute phase bf evolving myocardial infarction, but no clear evidence of benefit from the long-term use of aspirin after acute myocardial infarction (AMI) has been shown in any single study. This multicenter study, the Japanese Antiplatelets Myocardial Infarction Study, was performed to find out whether aspirin or trapidil would improve clinical outcome compared with no antiplatelets in postinfarction patients, The study was a multicenter, open-label, randomized controlled trial of aspirin 81 mg/day, trapidil 300 mg/day, and no antiplatelets in patients with AMI admitted within 1 month from the onset of symptoms, Seven hundred twenty-three patients were enrolled at 70 hospitals in 18 prefectures of Japan; 250 were randomly assigned to treatment with 81 mg aspirin (aspirin group), 243 to that with trapidil (trapidil group), and 230 were not given antiplatelet agents, The mean follow-vp period was 475 days. This study demonstrated that long-term use of aspirin at the dose of 81 mg/day reduced the incidence of recurrent AMI compared with the group receiving no antiplatelets after AMI (p = 0.0045) and that trapidil also reduced the occurrence of reinfarction compared with the group receiving no antiplatelets, but the difference was not significant (p = 0.0810), The incidence of cardiovascular events including cardiovascular death, reinfarction, uncontrolled unstable angina requiring admission to hospital, and nonfatal ischemic stroke was reduced in the group receiving 300 mg trapidil daily compared with the group receiving no antiplatelets (p = 0.0039), The use of aspirin 81 mg/day provided almost no benefit over no antiplatelets therapy in the incidence of cardiovascular events, In conclusion, low-dose aspirin (81 mg) effectively prevented recurrent AMI in postinfarction patients after thrombolysis or coronary angioplasty when used over a long term, Furthermore, the long-term use of trapidil resulted in a significant reduction in the incidence of cardiovascular events, (C) 1999 by Excerpta Medica, Inc.