| 摘要: |
| 目的 探究提前停服替格瑞洛（PTD）在急性冠状动脉综合征（ACS）患者中的发生率、原因及影响因素。方法 回顾性纳入2018年1月至10月于海军军医大学（第二军医大学）长海医院心血管内科使用阿司匹林和替格瑞洛双联抗血小板治疗的ACS住院患者400例，收集患者基线资料并随访，分析ACS患者PTD的发生率、原因和影响因素。结果 出院12个月时PTD患者49例（12.2%），未PTD患者351例（87.8%）。PTD组年龄>75岁、有心力衰竭病史、既往行经皮冠状动脉介入（PCI）的患者比例和血钾、尿素水平均高于未PTD组（P=0.004、0.031、0.028、0.037、0.001），使用β受体阻滞剂的患者比例和血管病变严重程度均低于未PTD组（P=0.041、0.018）。呼吸困难（22.4%，11/49）、当地无药（18.4%，9/49）和出血（12.2%，6/49）是导致PTD最常见的3个原因，改良英国医学研究理事会呼吸困难指数（mMRC）评分为2级及2级以上的呼吸困难患者均停服替格瑞洛（mMRC评分1级2例，2级6例，3级2例，4级1例）。Kaplan-Meier曲线分析PTD累积发生率结果显示，67.3%（33/49）的患者PTD发生在出院后90 d内。多因素logistic回归分析结果显示，年龄>75岁（OR=2.58，95% CI 1.26~5.26，P=0.009）和尿素水平升高（OR=1.17，95% CI 1.04~1.30，P=0.007）均为ACS患者PTD的独立预测因素，血管病变严重（OR=0.95，95% CI 0.92~0.98，P=0.001）是ACS患者坚持服用替格瑞洛的相关因素。结论 ACS患者双联抗血小板治疗期间PTD的发生率为12.2%。对于呼吸困难且mMRC评分为2级及2级以上的患者，临床应及时更换P2Y12受体拮抗剂。年龄>75岁为ACS患者PTD的独立预测因素，临床实践中应该高度重视服用替格瑞洛的高龄患者，关注其有无发生呼吸困难及PTD。 |
| 关键词: 急性冠状动脉综合征 双联抗血小板治疗 替格瑞洛 提前停药 |
| DOI：10.16781/j.0258-879x.2020.09.0984 |
| 投稿时间：2020-03-18修订日期：2020-05-11 |
| 基金项目:国家重点研发计划（2016YFC1301300，2016YFC1301303），国家自然科学基金（81170223）． |
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| Analysis of premature ticagrelor discontinuation in patients with acute coronary syndrome during dual antiplatelet therapy |
| XIAO Yu-chen1,GU Ying1,XU Ru-ming1,LI Pan1,CHEN Wei-sheng1,ZHAO Xian-xian1,MA Li-ping1,2* |
(1. Department of Cardiovasology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China;
2. Changhai Center for Simulation, Education and Research, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the incidence, causes and influencing factors of premature ticagrelor discontinuation (PTD) in patients with acute coronary syndrome (ACS). Methods A total of 400 hospitalized ACS patients who were treated with aspirin and ticagrelor in the Department of Cardiovasology, Changhai Hospital, Naval Medical University (Second Military Medical University) from Jan. to Oct. 2018 were retrospectively enrolled. Baseline data were collected and patients were followed up to analyze the incidence, causes and influencing factors of PTD in ACS patients. Results At 12 months after discharge, PTD occurred in 49 patients (12.2%), and was free in 351 patients (87.8%). The proportions of patients with age>75 years, heart failure history or previous percutaneous coronary intervention (PCI) and the levels of serum potassium and urea in PTD group were significantly higher than those in non-PTD group (P=0.004, 0.031, 0.028, 0.037, 0.001). The proportion of patients using β-blocker and the severity of vascular stenosis in PTD group were significantly lower than those in non-PTD group (P=0.041, 0.018). Dyspnea (22.4%, 11/49), drug unavailability (18.4%, 9/49) and bleeding (12.2%, 6/49) were the three most common causes of PTD. PTD occurred in all dyspnea patients with modified British Medical Research Council (mMRC) being grade 2 or higher (two cases with grade 1, six cases with grade 2, two cases with grade 3, and one case with grade 4). Kaplan-Meier curve analysis showed that 67.3% (33/49) of patients with PTD occurred within 90 days after discharge. Multivariate logistic regression analysis showed that age>75 years old (odds ratio [OR]=2.58, 95% confidence interval [CI] 1.26-5.26, P=0.009) and elevated urea (OR=1.17, 95% CI 1.04-1.30, P=0.007) were independent predictors of PTD in ACS patients, while severity of vascular stenosis (OR=0.95, 95% CI 0.92-0.98, P=0.001) was the related factor of adherence to ticagrelor. Conclusion The incidence of PTD in ACS patients during dual antiplatelet therapy is 12.2%. For dyspnea patients with mMRC score of grade 2 or higher, P2Y12 receptor antagonist should be replaced in time. Age> 75 years old is an independent predictor of PTD in ACS patients and more attention is needed for elderly patients taking ticagrelor whether they have dyspnea or PTD. |
| Key words: acute coronary syndrome dual antiplatelet therapy ticagrelor drug premature discontinuation |
