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首页> 外文期刊>Coronary artery disease >Quantification of the effect of clopidogrel on enzymatic infarct size related to a percutaneous coronary intervention in patients with acute coronary syndromes: Insights from the CHAMPION percutaneous coronary intervention trial
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Quantification of the effect of clopidogrel on enzymatic infarct size related to a percutaneous coronary intervention in patients with acute coronary syndromes: Insights from the CHAMPION percutaneous coronary intervention trial

机译：氯吡格雷对与急性冠脉综合征患者经皮冠状动脉介入治疗相关的酶促梗死面积的影响的定量研究：来自CHAMPION经皮冠状动脉介入治疗试验的启示

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OBJECTIVES: Using data from the CHAMPION percutaneous coronary intervention (PCI), we determined the relationship between clopidogrel started at least 5 days before PCI (maintenance of clopidogrel) and PCI-related enzymatic infarct size. BACKGROUND: Clopidogrel is recommended in patients with acute coronary syndrome (ACS) managed with PCI, but its effect on PCI-related myonecrosis in contemporary patients has not been quantified. PATIENTS AND METHODS: Patients with ACS (with or without ST-segment elevation) who underwent PCI and had at least three creatine kinase-MB (CK-MB) samples after PCI were included. Enzymatic infarct size was defined as the peak CK-MB concentration indexed by its upper limit of normal. Associations between maintenance clopidogrel and enzymatic infarct size were explored using multivariable linear regression (with and without missing data imputation) and propensity score analysis using inverse probability weighting. RESULTS: Of 8877 patients randomized, 6327 (71.3%) were included (median age 61 years, 73% male, 13% ACS with ST-segment elevation). Of these 6327 patients, 2015 (31.8%) were on maintenance clopidogrel. After multivariable adjustment, maintenance clopidogrel was associated with a reduction in enzymatic infarct size {β=-0.63; 47% decrease in peak CK-MB [95% confidence interval (CI) 35, 56%]}. Multivariable linear regression with multiple imputations and inverse probability weighting propensity score analysis yielded similar results, with maintenance clopidogrel associated with 44% (95% CI 33, 53%) and 29% (95% CI 24, 33%) infarct size reductions. CONCLUSION: In this subgroup analysis of modern ACS patients, clopidogrel maintenance was independently associated with smaller enzymatic infarct size after PCI. These results are consistent with previous observations suggesting a benefit of clopidogrel on the procedural outcome and quantify this benefit.
机译：目的：使用来自CHAMPION的经皮冠状动脉介入治疗（PCI）的数据，我们确定了氯吡格雷在PCI（维持氯吡格雷的治疗）前至少5天开始的氯吡格雷与PCI相关的酶促梗死面积之间的关系。背景：氯吡格雷被推荐用于接受PCI治疗的急性冠状动脉综合征（ACS）患者，但其对当代患者PCI相关性心肌坏死的影响尚未量化。患者和方法：纳入接受PCI且在PCI后至少有3个肌酸激酶-MB（CK-MB）样本的ACS患者（伴或不伴ST段抬高）。酶促梗死面积定义为CK-MB峰值浓度，以其正常上限为指标。使用多变量线性回归（有或没有缺失数据插补）和倾向得分分析（使用逆概率加权）探索维持氯吡格雷与酶促梗死面积之间的关联。结果：在随机分配的8877例患者中，纳入了6327例（71.3％）（中位年龄61岁，男性73％，ACS ST段抬高13％）。在这6327例患者中，2015年（31.8％）接受氯吡格雷维持治疗。经过多变量调整后，维持氯吡格雷与降低酶性梗死面积有关[β= -0.63;峰值CK-MB降低47％[95％置信区间（CI）35，56％]}。多元估算的多元线性回归和逆概率加权倾向得分分析得出了相似的结果，维持性氯吡格雷与梗死面积减少的比例分别为44％（95％CI 33，53％）和29％（95％CI 24，33％）。结论：在对现代ACS患者进行的亚组分析中，氯吡格雷的维持与PCI后较小的酶促梗死面积独立相关。这些结果与以前的观察结果一致，表明氯吡格雷对手术结果有益处并量化了这种益处。

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