基于P2Y12抑制剂的短期有效DAPT与基于氯吡格雷的DAPT：一项倾向匹配的现实世界研究。

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2025-07-26 DOI:10.1007/s10557-025-07750-w

Natchanon Kulsumritpon

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引用次数: 0

摘要

目的：本研究旨在评估在常规实践中，替格瑞或普拉格雷联合氯吡格雷治疗1个月是否比基于氯吡格雷的双重抗血小板治疗（DAPT）有任何临床优势。方法：我们对2015年至2021年在清莱Prachanukroh医院接受PCI治疗的ACS患者进行了回顾性、倾向匹配队列研究。患者按P2Y12方案分组：1个月有效的P2Y12抑制剂（替格瑞或普拉格雷），随后是氯吡格雷，或持续的氯吡格雷为基础的DAPT。所有患者均服用阿司匹林。使用倾向评分匹配和Cox回归来调整混杂因素。主要结局是1年内血栓再入院或全因死亡率的综合结果。以出血相关再入院作为安全终点进行评估。结果：共纳入1117例患者。配对后，各组间的主要综合结局无显著差异。在氯吡格雷vs替格瑞洛队列中（每组n = 161），校正风险比（HR）为1.09 (95% CI: 0.56-2.11；p = 0.808)。氯吡格雷vs普拉格雷（n = 139 /组），风险比为0.97 (95% CI: 0.43-2.22；p = 0.945)。在替格瑞或普拉格雷队列中（n = 275 /组），风险比为0.62 (95% CI: 0.33-1.17；p = 0.143)。LVEF结论：1个月疗程的强效P2Y12抑制剂与氯吡格雷在降低血栓再入院或死亡率方面并不优于基于氯吡格雷的DAPT。优化血运重建和心力衰竭治疗对高危患者仍然至关重要。

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Short-Course Potent P2Y₁₂ Inhibitor-Based DAPT Versus Clopidogrel-Based DAPT After PCI: A Propensity-Matched Real-World Study.

Purpose: This study aimed to evaluate whether a 1-month course of ticagrelor or prasugrel followed by clopidogrel offers any clinical advantage over clopidogrel-based dual antiplatelet therapy (DAPT) in routine practice.

Methods: We conducted a retrospective, propensity-matched cohort study of ACS patients who underwent PCI between 2015 and 2021 at Chiang Rai Prachanukroh Hospital. Patients were grouped by their P2Y₁₂ regimen: 1-month potent P2Y₁₂ inhibitor (ticagrelor or prasugrel) followed by clopidogrel, or continuous clopidogrel-based DAPT. All patients received aspirin. Propensity score matching and Cox regression were used to adjust for confounders. The primary outcome was a composite of thrombotic readmission or all-cause mortality at 1 year. Bleeding-related readmissions were assessed as the safety endpoint.

Results: A total of 1,117 patients were included. After matching, no significant differences were observed in the primary composite outcome across comparisons. In the clopidogrel vs. ticagrelor cohort (n = 161 per group), adjusted hazard ratio (HR) was 1.09 (95% CI: 0.56-2.11; P = 0.808). For clopidogrel vs. prasugrel (n = 139 per group), HR was 0.97 (95% CI: 0.43-2.22; P = 0.945). In the ticagrelor vs. prasugrel cohort (n = 275 per group), HR was 0.62 (95% CI: 0.33-1.17; P = 0.143). LVEF < 40% and residual coronary disease were independently associated with adverse outcomes (HR 4.44 and 8.39, respectively).

Conclusion: A 1-month course of potent P2Y₁₂ inhibitor followed by clopidogrel was not superior to clopidogrel-based DAPT in reducing thrombotic readmission or mortality. Optimizing revascularization and heart failure therapy remains essential in high-risk patients.

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.