双联抗血小板治疗可使重度PAD患者死亡率减半

一项回顾性、单中心研究，招募了348例接受阿司匹林+氯吡格雷DAPT的患者和281例接受阿司匹林单药治疗的患者，这些患者均患有PAD，有跛行或严重肢体缺血的典型表现。研究发现，接受双联抗血小板治疗（DAPT）的重度外周动脉疾病（PAD）患者，校正后3年全因死亡率比接受阿司匹林单药治疗的患者降低了45%。

 

华盛顿——与阿司匹林单药治疗相比，长期双联抗血小板治疗（DAPT）可能为症状性外周动脉疾病（PAD）患者带来生存获益。

加州大学戴维斯分校的Ehrin J. Armstrong博士在美国心脏病学会（ACC）年会上报告，在一项纳入629例跛行或严重肢体缺血患者的观察性研究中，348例接受阿司匹林+氯吡格雷DAPT的患者的3年全因死亡率为11%，而接受阿司匹林单药治疗的患者为21%。

而且，DAPT组的3年主要不良心血管事件（MACE）发生率也明显低于单药治疗组（20% vs. 28%）。不过，DAPT组的MACE获益主要源于死亡率的降低。两组的非致死性心肌梗死（MI）和卒中发生率相似，下肢旁路手术和大截肢术的发生率也相似。

DAPT组患者在基线血管造影检查时的糖尿病患病率明显高于单药治疗组（54% vs. 45%）。基线时，DAPT组的已知冠状动脉疾病患病率（56% vs. 45%）和β受体阻断剂使用率（55% vs. 48%）也更高。校正上述因素及其他潜在混杂因素的多变量回归分析显示，DAPT与死亡风险降低45%和MACE减少35%有关。

DAPT组和单药治疗组的死亡或大截肢术复合终点发生率分别为18%和27%，即DAPT组的相对风险显著降低了47%。

研究者称，尽管这项研究尚不具有决定性意义，但上述数据提示，对于症状性PAD患者值得考虑DAPT。

Armstrong博士报告称无相关利益冲突。

爱思唯尔版权所有  未经授权请勿转载

 

By: BRUCE JANCIN, Cardiology News Digital Network

AT ACC 14

VITALS

Major finding: Patients with severe peripheral artery disease who were on dual antiplatelet therapy had an adjusted 45% reduction in the 3-year risk of all-cause mortality compared with those on aspirin monotherapy.

Data source: A retrospective, single-center study of 348 patients on DAPT with aspirin and clopidogrel and 281 on aspirin alone, all with PAD marked by claudication or critical limb ischemia.

Disclosures: This study was conducted free of commercial support. The presenter reported having no financial conflicts.

WASHINGTON – Long-term dual-antiplatelet therapy may provide a mortality benefit over aspirin alone in patients with symptomatic peripheral artery disease.

In an observational study of 629 patients with claudication or critical limb ischemia, the 348 who were on dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel had a 3-year all-cause mortality rate of 11%, compared with 21% for those on aspirin monotherapy, Dr. Ehrin J. Armstrong said at the annual meeting of the American College of Cardiology.

The group on DAPT also had a significantly lower 3-year rate of major adverse cardiovascular events: 20%, compared with 28% in the monotherapy group. However, this was driven by the reduced risk of mortality. Rates of nonfatal MI and stroke were similar in the two groups. So were rates of lower extremity bypass surgery and major amputations, according to Dr. Armstrong, a cardiologist at the University of California, Davis.

The group on DAPT had a significantly higher baseline prevalence of diabetes at the time of angiography: 54%, compared with 45% for patients on aspirin alone. The DAPT group also had a higher baseline prevalence of known coronary artery disease – 56% vs. 45% – and greater use of beta-blockers, by a margin of 55%, compared with 48%. In a multivariate regression analysis adjusted for these and other potential confounders, DAPT was associated with a 45% reduction in the risk of mortality and a 35% decrease in major adverse cardiovascular events.

The rate of the combined endpoint of death or major amputation was 18% in the DAPT group and 27% with aspirin monotherapy, for a highly significant 47% relative risk reduction.

Although a study such as this can’t be considered definitive, these data suggest DAPT is worth considering in patients with symptomatic peripheral artery disease, the cardiologist said.

He reported having no financial conflicts of interest.