Circulation:坎格雷洛对PCI术后男性vs.女性的疗效和安全性( CHAMPION PHOENIX 研究)

2016-01-18 崔倩 译 MedSci原创

坎格雷洛是一种静脉内ADP受体拮抗剂,导致有效的和可逆的抑制血小板聚集的作用。一些抗血小板药物在女性中的相对安全性和有效性一直存在争议。该CHAMPION PHOENIX试验随机选取11145名择期或紧急PCI的患者接受坎格雷洛或氯吡格雷。主要疗效终点是在48小时的死亡,心肌梗死,缺血驱动的血运重建,或支架血栓(ST)时复合终点;关键的次要终点是在48小时的ST。主要安全终点是在48小时时GUST

坎格雷洛是一种静脉内ADP受体拮抗剂,可以有效地可逆性地抑制血小板的聚集作用。一些抗血小板药物在女性中的相对安全性和有效性一直存在争议。

该CHAMPION PHOENIX试验随机选取了11145名择期或紧急PCI的患者接受坎格雷洛(坎格瑞洛)或氯吡格雷。主要疗效终点是48h的死亡、心肌梗死、血运重建或支架血栓形成(ST)时的复合终点;关键的次要终点是48h的ST。主要安全终点是48h内的“通用链激酶与t-PA针对冠脉闭塞(GUSTO)”定义的严重出血。在分析的受试者中,3051(28%)为女性。与氯吡格雷相比,坎格雷洛对于女性减少了主要终点的35%(调整OR 0.65,0.48-0.89),在男性中减少了14%(OR 0.86,95%Cl 0.70-1.05;相互P=0.23)。坎格雷洛降低了61%女性发生的ST的可能性(OR 0.39,95%Cl 0.20-0.77),在男性中减少了16%(OR 0.84,95%CI 0.53-1.33;相互p=0.11)。与氯吡格雷相比,坎格雷洛导致严重出血的几率是在女性和男性中是相似的[0.3% vs 0.2%,P=0.30(女性);0.1% vs 0.1%,P=0.41(男性);相互P=0.88]。坎格雷洛增加了女性中度出血的可能性(0.9% vs 0.3%,p=0.02),在男性中没有增加(0.2% vs 0.2%,P=0.68,相互P=0.040)。坎格雷洛对于女性(OR 0.68,0.50-0.92)和男性(OR 0.87,95%Cl 0.71-1.06,相互P=0.26)的净效益都较高(主要疗效和安全性终点)。

在CHAMPION PHOENIX试验中,坎格雷洛降低了男性和女性的主要心血管不良事件和支架血栓形成的发生率,似乎比氯吡格雷有更大的净效益。

原始出处:

O'Donoghue ML,Bhatt DL,Stone GW,et al.The Efficacy and Safety of Cangrelor in Women Versus Men During PCI,Circulation,2016.1.14

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    2016-07-21 zxl736
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