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首页> 外文期刊>The American Journal of Cardiology >Prognostic Impact of Clopidogrel Pretreatment in Patients With Acute Coronary Syndrome Managed Invasively
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Prognostic Impact of Clopidogrel Pretreatment in Patients With Acute Coronary Syndrome Managed Invasively

机译：氯吡格雷预处理对急性冠脉综合征患者的预后影响

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Pretreatment with antiP2Y(12) agents before angiography in acute coronary syndrome (ACS) is associated with a reduction in thrombotic events. However, recent evidences have questioned the benefits of upstream antiP2Y12, reporting a higher incidence of bleeding. We analyzed the prognostic impact of clopidogrel pretreatment in a large cohort of invasively managed patients with ACS. In hospital, safety and efficacy of clopidogrel pretreatment were retrospectively analyzed in patients included in the ARIAM-Andalucia Registry (Analysis of Delay in Acute Myocardial Infarction). Propensity score and inverse probability of treatment weighting analysis were performed to control treatment selection bias. Results were stratified by ACS type. Sensitivity analyses were used to explore stability of the overall treatment effect. Of 9,621 patients managed invasively, 69% received clopidogrel before coronary angiography. In the ST-elevation myocardial infarction group, pretreatment was associated with a significant reduction in reinfarction (odds ratio 0.53, 95% confidence interval [CI] 0.27 to 0.96; p = 0.027), stent thrombosis (odds ratio 0.15, 95% CI 0.06 to 0.38; p<0.0001), and mortality (odds ratio 0.67,95% CI 0.48 to 0.94; p = 0.020), with an increase in minor bleeding but remained as a net clinical benefit strategy. Those benefits were not present in patients without ST elevation (non ST elevation ACS). The weighting and propensity analysis "confirmed the same results. An interaction between pretreatment duration and bleeding was observed. In conclusion, pretreatment with clopidogrel reduced the occurrence of death and thrombotic outcomes at the cost of minor bleeding. Those benefits exclusively affected ST-elevation myocardial infarction cases. The potential benefit of routine upstream pretreatment in patients with non ST-elevation ACS should be reappraised at the present. (C) 2015 Elsevier Inc. All rights reserved.
机译：在急性冠状动脉综合征（ACS）进行血管造影之前用antiP2Y（12）药物进行预处理与血栓形成事件的减少有关。但是，最近的证据质疑上游抗P2Y12的益处，据报道出血的发生率更高。我们分析了氯吡格雷预处理对一大批ACS侵入性管理患者的预后影响。在医院，回顾性分析了ARIAM-安达卢西亚注册中心（急性心肌梗死延迟分析）患者的氯吡格雷预处理的安全性和有效性。进行倾向得分和治疗加权分析的逆概率，以控制治疗选择偏倚。结果按ACS类型分层。敏感性分析用于探讨整体治疗效果的稳定性。在9,621例接受侵入性治疗的患者中，有69％的患者在冠状动脉造影之前接受了氯吡格雷治疗。在ST抬高型心肌梗死组中，预处理与再梗塞的显着减少（几率0.53，95％置信区间[CI] 0.27至0.96; p = 0.027），支架内血栓形成（几率0.15、95％CI 0.06）相关。降低至0.38; p <0.0001）和死亡率（赔率比0.67,95％CI从0.48降低至0.94; p = 0.020），并伴有轻微出血的增加，但仍作为一项临床获益策略。没有ST抬高（非ST抬高ACS）的患者没有这些益处。权重和倾向分析“证实了相同的结果。观察到预处理持续时间与出血之间的相互作用。总之，氯吡格雷预处理减少了死亡和血栓形成的发生，但以轻度出血为代价。这些益处完全影响了ST抬高心肌目前应重新评估非ST段抬高ACS患者常规上游预处理的潜在益处（C）2015 Elsevier Inc.保留所有权利。

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