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首页> 美国卫生研究院文献>Frontiers in Neurology >The Dipyridamole Added to Dual Antiplatelet Therapy in Cerebral Infarction After First Acute Myocardial Infarction: A Nationwide Case-Control Study
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The Dipyridamole Added to Dual Antiplatelet Therapy in Cerebral Infarction After First Acute Myocardial Infarction: A Nationwide Case-Control Study

机译：首次急性心肌梗死后在双联抗血小板治疗脑梗死中添加双嘧达莫的研究：全国性病例对照研究

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>Background and Purpose: No previous study has compared the impact of dipyridamole-based triple antiplatelet therapy on secondary stroke prevention and long-term outcomes to that of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI) and previous stroke. This study aimed to evaluate the impact of dipyridamole added to DAPT on stroke prevention and long-term outcomes in patients with cerebral infarction after first AMI.>Methods: This nationwide, case-control study included 75,789 patients with cerebral infarction after first AMI. A 1:4 propensity score matching ratio was adopted based on multiple variables. Finally, the data of 4,468 patients included in the DAPT group and 1,117 patients included in the Dipyridamole-DAPT group were analyzed. Primary outcome was overall survival. Secondary outcomes were cumulative event rate of recurrent MI or stroke, and cumulative intracerebral hemorrhage (ICH) and gastrointestinal bleeding rate.>Results: Long-term survival rate was comparable between the two groups (log-rank P = 0.1117), regardless of sex analyses. However, after first year, DAPT subgroup revealed better survival over DAPT-dipyridamole subgroup (log-rank P = 0.0188). In age subgroup analysis, a lower survival rate was detected in younger patients from the Dipyridamole-DAPT group after first year (log-rank P = 0.0151), but no survival difference for older patients. No benefit of Dipyridamole-DAPT was detected for patients after AMI, regardless of the myocardial infarction type. DAPT was superior to Dipyridamole-DAPT in patients who underwent percutaneous coronary intervention (PCI) (log-rank P = 0.0153) and ST elevation myocardial infarction after first year (log-rank P = 0.0019). Dipyridamole-DAPT did not reduce cumulative event rate of recurrent MI or stroke in patients after AMI. Moreover, Dipyridamole-DAPT increased the cumulative ICH rate (log-rank P = 0.0026), but did not affect the cumulative event rate of gastrointestinal bleeding. In Cox analysis, dipyridamole did not improve long-term survival.>Conclusions: This nationwide study showed that Dipyridamole-DAPT, compared with DAPT, did not improve long-term survival in patients with stroke after AMI, and was related to poor outcomes after 1 year. Dipyridamole-DAPT did not reduce recurrent rate of MI or stroke, but increased the ICH rate without impacting the incidence of gastrointestinal bleeding.
机译：>背景和目的：在急性心肌梗死患者中，基于双嘧达莫的三联抗血小板治疗对继发性卒中预防和长期结局的影响与双抗血小板治疗（DAPT）相比没有（ AMI）和以前的中风。这项研究旨在评估添加双嘧达莫对首次AMI后脑梗死患者中风预防和长期预后的影响。>方法：这项全国性病例对照研究包括75,789例脑卒中患者首次AMI后发生梗死。基于多个变量，采用1：4的倾向得分匹配率。最后，分析了DAPT组中4468例患者和双嘧达莫-DAPT组中1117例患者的数据。主要结局是总体生存率。次要结果是复发性MI或中风的累积事件发生率，累积性脑出血（ICH）和胃肠道出血发生率。>结果：两组的长期生存率具有可比性（log-rank P = 0.1117），无论性别分析如何。然而，第一年后，DAPT亚组的生存率优于DAPT-双嘧达莫亚组（log-rank P = 0.0188）。在年龄亚组分析中，第一年后双嘧达莫-DAPT组的年轻患者的生存率较低（对数秩P = 0.0151），但老年患者的生存率无差异。无论心肌梗塞类型如何，AMI后患者均未检测到双嘧达莫-DAPT的益处。在第一年后接受经皮冠状动脉介入治疗（PCI）（log-rank P = 0.0153）和ST抬高型心肌梗死的患者（DA-rank P = 0.0019），DAPT优于双嘧达莫-DAPT。双嘧达莫-DAPT不能降低AMI患者复发性MI或中风的累积发生率。此外，双嘧达莫-DAPT增加了累积ICH发生率（log-rank P = 0.0026），但并未影响胃肠道出血的累积事件发生率。在Cox分析中，双嘧达莫不能改善长期生存。>结论：这项全国性研究表明，与DAPT相比，双嘧达莫-DAPT不能改善AMI后中风患者的长期生存。与1年后的不良结局有关。双嘧达莫-DAPT不会降低MI或中风的复发率，但会增加ICH率，而不会影响胃肠道出血的发生率。

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