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利尿剂对氯吡格雷抗栓治疗的PCI术后急性冠脉综合征患者预后的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2014年第2期
页码:
163-167
栏目:
临床研究
出版日期:
2014-01-20

文章信息/Info

Title:
Influence of diuretics on anti-platelet effect of clopidogrel in patients with acute coronary syndrome after percutaneous coronary intervention
作者:
陈 曦; 张蓝宁; 李晓琪; 李 泱; 尹 彤
(解放军总医院老年心血管病研究所，北京100853)
Author(s):
CHEN Xi;  ZHANG Lan-ning;  LI Xiao-qi;  LI Yang;  YIN Tong
(Institute of Geriatric Cardiology, PLA General Hospital, Beijing 100853, China)
关键词:
利尿剂; 氯吡格雷; 经皮冠状动脉介入治疗; 急性冠脉综合征; 缺血终点事件
Keywords:
diuretics;  clopidogrel;  percutaneous coronary intervention;  acute coronary syndrome;  cardiac ischemic events
分类号:
R284.1
DOI:
-
文献标识码:
A
摘要:
目的:探讨利尿剂对急性冠脉综合征（acute coronary syndrome，ACS）患者经皮冠状动脉介入（percutaneous coronary intervention，PCI）术后氯吡格雷抗血小板治疗预后的影响。方法： 根据入选和排除标准，前瞻性连续募集2009年9月~2011年9月，在解放军总医院老年心血管病研究所住院行氯吡格雷抗血小板治疗的PCI术后ACS患者，并对其心血管主要缺血终点事件（心源性死亡，非致死性心肌梗死或者脑卒中，紧急冠状动脉血运重建）和联合缺血终点事件（主要缺血终点事件及明确或可疑支架内血栓形成，复发性心肌缺血或者不稳定型心绞痛再入院治疗，非紧急血运重建）的发生情况进行为期1年的随访。分别利用Logistic多元回归、Kaplan-Meier曲线及Cox多元回归等统计方法，分析利尿剂对PCI术后经氯吡格雷抗血小板治疗的ACS患者心血管缺血终点事件的影响。结果： 在750例符合入选标准的PCI术后经氯吡格雷抗血小板治疗的ACS患者中，664例患者完成了为期1年的心血管缺血终点事件的随访。对发生缺血终点事件（n=164）和未发生缺血终点事件（n=500）患者的一般情况和临床特征的单因素比较分析发现，年龄、他汀类药物、血管紧张素转化酶抑制剂/血管紧张素受体阻断剂和利尿剂的应用在两组患者之间具有显著性的差异（P<0.05,P<0.01）。Logistic多元回归分析发现，联合应用利尿剂是心血管主要缺血终点事件（OR：2.99，95%CI：1.37-6.54，P<0.01）及联合缺血终点事件（OR：2.37，95%CI：1.53-3.68，P<0.01）发生的独立危险因素。Kaplan-Meier曲线和Cox 多元回归分析均发现，联合应用利尿剂的患者1年内发生联合缺血终点事件的风险显著高于未使用利尿剂的患者（P<0.01）。结论： 联合应用利尿剂增加了经氯吡格雷抗血小板治疗的PCI术后ACS患者心血管缺血终点事件发生的风险。
Abstract:
AIM:To investigate the influence of diuretics on the anti-platelet effect of clopidogrel in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). METHODS: Consecutive post-PCI ACS patients treated with clopidogrel in our hospital from September 2009 to September 2011 were recruited and followed-up for 1 year. General and clinical characteristics were compared between patients with and without cardiac endpoints by univariate analysis. Logistic regression, Kaplan-Meier curves and Cox regression were used to analyze the influence of diuretics on major adverse cardiac events (MACE, including cardiac death, nonfatal acute myocardial infarction or stroke and emergent coronary revascularization) or composite events (including MACE, definite or suspicious stent thrombosis, hospitalization for recurrent myocardial ischemia or unstable angina and non-emergent coronary revascularization) in patients treated with clopidogrel. RESULTS: A total of 750 consecutive post PCI ACS patients treated with clopidogrel were recruited, of whom 664 patients completed the 1-year follow-up. Univariate analysis showed that age and use of stains, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and diuretics were significantly different between patients with (n=164) and without (n=500) events (P<0.05, P<0.01). Logistic regression analysis indicated that use of diuretics was the independent risk factor for MACE (OR: 2.99, 95% CI: 1.37-6.54, P<0.01) and composite events (OR: 2.37, 95% CI: 1.53-3.68, P<0.01). Kaplan-Meier curves and Cox regression showed that the cumulative hazard of composite events was significantly higher in patients treated with diuretics than those without diuretics (P<0.01). CONCLUSION: Diuretics increases the risk for cardiac ischemic events in post-PCI ACS patients treated with clopidogrel.

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备注/Memo

备注/Memo:
收稿日期：2013-08-04.
基金项目：国家自然科学基金重点项目资助（81030002）；解放军总医院临床扶持基金资助（2012FC-TSYS-3042）；国家自然科学基金青年基金资助（ 81100215）
通讯作者：尹彤，副研究员，主要从事抗凝抗栓药物基因组学研究Email：yintong2000@yahoo.com 共同
通讯作者：李泱，研究员，主要从事心血管疾病临床基础研究Email：liyangbsh@163.com
作者简介：陈曦，硕士生Email：cx2
更新日期/Last Update: 2014-01-16