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目的:了解冠状动脉支架置入术后患者对抗血小板治疗的依从性及其对临床预后的影响。方法:对504例行冠状动脉内支架置入术的患者进行临床随访,调查抗血小板药物的应用情况及主要不良心脏事件(MACE)。结果:平均随访6～57(21.19±11.75)个月。术后498例(98.8%)的患者应用阿司匹林,503例(99.8%)的患者使用氯吡格雷,其应用时间为(9.56±3.95)个月。随访时64例患者擅自停用氯吡格雷,33例(6.55%)患者未服用阿司匹林;30例(5.95%)停止所有的抗血小板治疗。完全停止抗血小板治疗使非致死性心肌梗死(MI)(10.00%∶1.05%,OR9.77,95%CI2.32～40.10,P<0.01)及MACE(20.00%∶7.38%,OR3.25,95%CI1.26～8.41,P<0.05)的发生明显增加。通过logistic多元回归校正组间不匹配因素后,这种关系依然存在(非致死性MI,OR15.35,95%CI2.02～78.06,P<0.01;MACEOR3.21,95%CI1.19～8.65,P<0.05)。结论:冠状动脉支架置入术后患者对抗血小板治疗的依从性良好,完全停止抗血小板治疗会增加非致死性MI及MACE的危险。
OBJECTIVE: To understand the compliance of patients with antiplatelet therapy after coronary stenting and its impact on clinical prognosis. Methods: 504 patients undergoing coronary stenting were followed up to investigate the use of antiplatelet drugs and major adverse cardiac events (MACE). Results: The average follow-up ranged from 6 to 57 (21.19 ± 11.75) months. Aspirin was given to 498 patients (98.8%) after surgery, and clopidogrel was used in 503 patients (99.8%) for a period of (9.56 ± 3.95) months. Sixty-four patients discontinued clopidogrel without follow-up, 33 patients (6.55%) took aspirin, and 30 (5.95%) discontinued all antiplatelet therapy. Complete discontinuation of antiplatelet therapy led to a decrease in non-fatal myocardial infarction (MI) (10.00% vs. 1.05%, OR 9.77, 95% CI 2.32 to 40.10, P <0.01) 95% CI1.26 ~ 8.41, P <0.05) increased significantly. This relationship persisted after adjusting for mismatch between groups by logistic multivariate regression (non-fatal MI, OR 15.35, 95% CI 2.02-78.06, P <0.01; MACEOR 3.21, 95% CI 1.19-8.65 , P <0.05). Conclusions: Compliance with antiplatelet therapy is good in patients undergoing coronary stenting, and complete cessation of antiplatelet therapy increases the risk of non-fatal MI and MACE.