J Am Coll Cardiol Intv:STEMI患者直接PCI术后抗凝或可降低院内死亡率

2022-02-13 “ Clinic門诊新视野”公众号 “ Clinic門诊新视野”公众号

2022年2月7日,美国心脏病学会杂志—心血管介入子刊(

2022年2月7日,美国心脏病学会杂志—心血管介入子刊(J Am Coll Cardiol Intv; 2020/2021 JCR IF 11.195)在线发表首都医科大学附属北京安贞医院聂绍平教授团队等的论着“Post-procedure Anticoagulation in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention” 。该研究基于中国心血管疾病医疗质量改善(CCC-ACS)项目数据,首次提示STEMI 患者直接PCI术后抗凝(PPAC)与院内死亡率降低相关,且不增加院内大出血风险

此前,对于ST段抬高型心肌梗死(STEMI)患者直接PCI术后抗凝能否获益一直缺乏关键证据,虽然抗凝治疗可能预防复发性缺血风险,但潜在的出血风险可能抵消其获益。

聂绍平教授团队与法国国家健康和医学研究院Gilles Montalescot教授团队合作,利用我国与美国心脏协会(AHA)合作开展的CCC-ACS项目2014年至2019年间的数据,根据是否接受术后抗凝对所有STEMI直接PCI的患者进行分组。通过逆概率处理加权法(IPTW)和以医院为随机效应的Cox比例风险模型分析院内临床结局的差异。主要有效性终点为全因死亡,主要安全性终点为大出血。

在34,826例符合入排条件的STEMI直接PCI患者中,有26,272例(75.4%) 接受了术后抗凝治疗。与未进行术后抗凝的患者相比,接受术后抗凝的患者平均年龄更小、入院时病情更稳定、出血风险评分更低,合并症和多支病变更多,且多在症状出现后12小时内接受直接PCI。在对基线差异进行逆概率处理加权后,术后抗凝与院内死亡率显着降低相关(0.9% vs 1.8%;HR 0.62;P<0.001),且院内大出血风险无显着差异(2.5% vs 2.2%;HR 1.05;P=0.14)。

作者指出,鉴于2013年ACC/AHA STEMI指南并未提及直接PCI术后抗凝问题,以及2017年ESC STEMI指南不建议常规术后抗凝(除非有抗凝的明确适应症)的推荐,既往在临床实践中各家医院或医生们对此有不同偏好,差异很大,但均无高质量的数据支持。此研究收集数据阶段恰逢指南的更新,随着时间的推移,观察到死亡率和出血风险的降低,以及术后抗凝使用比率的显着下降。

作者认为,该分析的结果为STEMI直接PCI术后抗凝的应用提供数据支持,需要大规模随机对照临床试验进行该假设的验证。

JACC心血管介入子刊同期还配发了意大利坎帕尼亚大学Felice Gragnano等撰写的题为“直接PCI术后抗凝—机遇和不确定性并存的领域(Anticoagulation After Primary PCI-The Land of Promises and Uncertainty)” 的专家述评[2]。尽管该观察性研究存在一定缺陷,但其样本量大且来自真实世界人群,其结果无疑具有重要的价值,有助于阐明当代 STEMI 患者处理中的一个关键临床问题。

该述评作者还引用了古罗马圣师、基督教思想家圣奥古斯丁(St. Augustine)的名言:“我们能力不足,无法单靠推理来发现真相” 。STEMI术后抗凝的领域充满期待,正在进行的RIGHT研究为此带来更多证据支持。

据悉,由聂绍平教授团队牵头、国内近五十家中心参与的双盲、安慰剂随机对照试验——RIGHT研究(NCT03664180)系国际上首个评估直接PCI术后延长抗凝的随机试验,目前该研究已完成入组并进入随访阶段,其结果将填补该领域的空白,为STEMI患者直接PCI术后抗凝管理提供强有力的证据。

原始出处:

Yan Y, Gong W, Ma C, et al. Post-procedure anticoagulation in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol Intv. 2022;15(3):251–263.

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    2022-11-02 xuyu
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    2022-09-08 zxl736
  4. 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GetPortalCommentsPageByObjectIdResponse(id=1486460, encodeId=2258148646037, content=<a href='/topic/show?id=76291384571' target=_blank style='color:#2F92EE;'>#PCI术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13845, encryptionId=76291384571, topicName=PCI术后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ea78134582, createdName=12499e01m49暂无昵称, createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1193209, encodeId=fa9411932090a, content=至北京时间2022年2月14日8时01分,, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Feb 14 09:17:18 CST 2022, time=2022-02-14, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1782146, encodeId=02811e8214674, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Sun Jul 24 15:12:31 CST 2022, time=2022-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749123, encodeId=b3191e49123eb, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, 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style='color:#2F92EE;'>#Coll#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4996, encryptionId=f16a499652, topicName=Coll)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07f7192, createdName=waiwai3030, createdTime=Wed Jan 04 07:12:31 CST 2023, time=2023-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1482340, encodeId=0bd3148234068, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486460, encodeId=2258148646037, content=<a href='/topic/show?id=76291384571' target=_blank style='color:#2F92EE;'>#PCI术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13845, encryptionId=76291384571, topicName=PCI术后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ea78134582, createdName=12499e01m49暂无昵称, createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1193209, encodeId=fa9411932090a, content=至北京时间2022年2月14日8时01分,, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Feb 14 09:17:18 CST 2022, time=2022-02-14, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1782146, encodeId=02811e8214674, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Sun Jul 24 15:12:31 CST 2022, time=2022-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749123, encodeId=b3191e49123eb, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Wed Nov 02 22:12:31 CST 2022, time=2022-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633871, encodeId=b85616338e138, content=<a href='/topic/show?id=578d13843ad' target=_blank style='color:#2F92EE;'>#PCI术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13843, encryptionId=578d13843ad, topicName=PCI术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ea4322051797, createdName=zxl736, createdTime=Thu Sep 08 22:12:31 CST 2022, time=2022-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635256, encodeId=6f88163525629, content=<a href='/topic/show?id=bb41983049e' target=_blank style='color:#2F92EE;'>#院内死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, 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style='color:#2F92EE;'>#Coll#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4996, encryptionId=f16a499652, topicName=Coll)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07f7192, createdName=waiwai3030, createdTime=Wed Jan 04 07:12:31 CST 2023, time=2023-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1482340, encodeId=0bd3148234068, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486460, encodeId=2258148646037, content=<a href='/topic/show?id=76291384571' target=_blank style='color:#2F92EE;'>#PCI术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13845, encryptionId=76291384571, topicName=PCI术后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ea78134582, createdName=12499e01m49暂无昵称, createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1193209, encodeId=fa9411932090a, content=至北京时间2022年2月14日8时01分,, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Feb 14 09:17:18 CST 2022, time=2022-02-14, status=1, ipAttribution=)]
    2023-01-04 waiwai3030
  7. [GetPortalCommentsPageByObjectIdResponse(id=1782146, encodeId=02811e8214674, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Sun Jul 24 15:12:31 CST 2022, time=2022-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749123, encodeId=b3191e49123eb, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cef136235391, createdName=xuyu, createdTime=Wed Nov 02 22:12:31 CST 2022, time=2022-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1633871, encodeId=b85616338e138, content=<a href='/topic/show?id=578d13843ad' target=_blank style='color:#2F92EE;'>#PCI术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13843, encryptionId=578d13843ad, topicName=PCI术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ea4322051797, createdName=zxl736, createdTime=Thu Sep 08 22:12:31 CST 2022, time=2022-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635256, encodeId=6f88163525629, content=<a href='/topic/show?id=bb41983049e' target=_blank style='color:#2F92EE;'>#院内死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98304, encryptionId=bb41983049e, topicName=院内死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f122436081, createdName=yuhaisheng_ibp_32061718, createdTime=Tue Aug 16 05:12:31 CST 2022, time=2022-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1936746, encodeId=7fd91936e46d6, content=<a href='/topic/show?id=74bd16e850c' target=_blank style='color:#2F92EE;'>#STEMI患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16785, encryptionId=74bd16e850c, topicName=STEMI患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Fri Oct 28 00:12:31 CST 2022, time=2022-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1783394, encodeId=24f41e8339477, content=<a href='/topic/show?id=f16a499652' target=_blank style='color:#2F92EE;'>#Coll#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4996, encryptionId=f16a499652, topicName=Coll)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=07f7192, createdName=waiwai3030, createdTime=Wed Jan 04 07:12:31 CST 2023, time=2023-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1482340, encodeId=0bd3148234068, content=<a href='/topic/show?id=8cc416e78f3' target=_blank style='color:#2F92EE;'>#STEM#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16778, encryptionId=8cc416e78f3, topicName=STEM)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d1067833268, createdName=12498bb3m92(暂无昵称), createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1486460, encodeId=2258148646037, content=<a href='/topic/show?id=76291384571' target=_blank style='color:#2F92EE;'>#PCI术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13845, encryptionId=76291384571, topicName=PCI术后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ea78134582, createdName=12499e01m49暂无昵称, createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1193209, encodeId=fa9411932090a, content=至北京时间2022年2月14日8时01分,, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Feb 14 09:17:18 CST 2022, time=2022-02-14, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1782146, encodeId=02811e8214674, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Sun Jul 24 15:12:31 CST 2022, time=2022-07-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1749123, encodeId=b3191e49123eb, content=<a href='/topic/show?id=843ee2425a1' target=_blank style='color:#2F92EE;'>#直接PCI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72425, encryptionId=843ee2425a1, topicName=直接PCI)], attachment=null, authenticateStatus=null, createdAvatar=null, 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GetPortalCommentsPageByObjectIdResponse(id=1486460, encodeId=2258148646037, content=<a href='/topic/show?id=76291384571' target=_blank style='color:#2F92EE;'>#PCI术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13845, encryptionId=76291384571, topicName=PCI术后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ea78134582, createdName=12499e01m49暂无昵称, createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1193209, encodeId=fa9411932090a, content=至北京时间2022年2月14日8时01分,, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, 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  9. 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GetPortalCommentsPageByObjectIdResponse(id=1486460, encodeId=2258148646037, content=<a href='/topic/show?id=76291384571' target=_blank style='color:#2F92EE;'>#PCI术后#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13845, encryptionId=76291384571, topicName=PCI术后)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4ea78134582, createdName=12499e01m49暂无昵称, createdTime=Tue Feb 15 06:12:31 CST 2022, time=2022-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1193209, encodeId=fa9411932090a, content=至北京时间2022年2月14日8时01分,, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIrrxxDxnLic8t6EAs38Qfwo6H2h6JMleIgb9OSYf6LMnVDkQEqUXWoSDWboibjhOBI9SJDTXweqQIA/132, createdBy=50aa5321359, createdName=查查佳佳, createdTime=Mon Feb 14 09:17:18 CST 2022, time=2022-02-14, status=1, ipAttribution=)]
    2022-02-14 查查佳佳

    至北京时间2022年2月14日8时01分,

    0

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