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首页> 外文期刊>The American Journal of Cardiology >Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Chronic Total Occlusion
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Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention for Chronic Total Occlusion

机译：经皮冠状动脉干预后双抗血小板治疗的持续时间慢性总闭塞

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The optimal duration of dual antiplatelet therapy (DAPT) after treatment of chronic total occlusions (CTO) with percutaneous coronary intervention (PCI) is unknown. We aimed to determine if extended (> 12 months) DAPT was associated with a net clinical benefit. The study population included patients who underwent successful CTO PCI within Kaiser Permanente Northern California between 2009 and 2016. Baseline demographic, clinical, and procedural characteristics were compared for patients on DAPT 12 months. Clinical outcomes (death, myocardial infarction (MI), and >= Academic Research Consortium type 3a bleeding) were compared beginning 12 months after PCI using Cox proportional hazards models. We also adjudicated individual causes of death. 1,069 patients were followed for a median of 3.6 years (Interquartile Range = 2.2 to 5.5) following CTO PCI. Patients on DAPT = 12 months (n = 597, 56%) were more likely to have anemia, end stage renal disease, and previous MI. After adjustment for between group differences, > 12 months of DAPT was associated with lower death or MI (hazard ratio [HR]: 0.66; 95% confidence interval [CI]: 0.47 to 0.93) and lower death (HR: 0.54; 95% CI: 0.36 to 0.82). There were no associations with MI (HR: 0.91; 95% CI: 0.55 to 1.5) or bleeding (HR 1.1; 95% CI: 0.50 to 2.4), but a numerically higher proportion of patients on shorter v. longer DAPT died of a cardiovascular cause (37% vs 20%, p = 0.10). In conclusion, > 12 months of DAPT was associated with lower death or MI, without an increase in bleeding. Prospective studies are needed to evaluate the optimal duration of DAPT in this unique subgroup. (C) 2020 Elsevier Inc. All rights reserved.
机译：经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）后，双重抗血小板治疗（DAPT）的最佳持续时间尚不清楚。我们的目的是确定延长（>12个月）的DAPT是否与临床净效益相关。研究人群包括2009年至2016年间在北加州凯泽永久医院成功接受CTO PCI的患者。对接受DAPT 12个月的患者的基线人口统计学、临床和程序特征进行比较。采用Cox比例风险模型对PCI术后12个月开始的临床结果（死亡、心肌梗死（MI）和>=学术研究联盟3a型出血）进行比较。我们还裁定了个别死亡原因。1069名患者在CTO PCI术后接受了中位数为3.6年的随访（四分位间距=2.2至5.5）。接受DAPT=12个月（n=597，56%）的患者更有可能患贫血、终末期肾病和既往心肌梗死。在调整组间差异后，DAPT治疗超过12个月与较低的死亡率或心肌梗死（危险比[HR]：0.66；95%可信区间[CI]：0.47至0.93）和较低的死亡率（HR:0.54；95%可信区间：0.36至0.82）相关。与心肌梗死（HR:0.91；95%可信区间：0.55至1.5）或出血（HR:1.1；95%可信区间：0.50至2.4）无关，但接受短v.长DAPT的患者死于心血管原因的比例较高（37%对20%，p=0.10）。总之，>12个月的DAPT与较低的死亡率或心肌梗死相关，且出血量没有增加。在这个独特的亚组中，需要进行前瞻性研究来评估DAPT的最佳持续时间。（C） 2020爱思唯尔公司版权所有。

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