双联抗血小板治疗时程对冠状动脉非阻塞性心肌梗死患者临床结局的影响

doi:10.3969/j.issn.1006-6233.2025.02.015

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摘要 目的: 探讨双联抗血小板治疗(DAPT)时程对冠状动脉(冠脉)非阻塞性心肌梗死(MINOCA)患者临床结局的影响。方法: 连续纳入2016年1月至2023年12月于承德市中心医院住院行冠脉造影检查并诊断为MINOCA患者111例,根据DAPT治疗持续时间分为短程DAPT组(持续1~3个月DAPT组,59例)和长程DAPT组(持续3~6个月DAPT组,52例)。绘制Kaplan-Meier 曲线并进行Cox比例风险回归评估DAPT时程对临床结局的影响。结果: 短程DAPT组和长程DAPT组患者的主要终点事件发生率为23.7%和19.2%,差异无统计学意义(P=0.566)。Kaplan-Meier分析提示短程DAPT的主要终点结果与长程DAPT相似(log-rank P=0.535)。Cox回归分析显示,与短期DAPT相比,长期DAPT与主要终点事件风险降低无关(风险比[HR]:1.310,95%置信区间[CI]:0.582~2.399,P=0.514)。至于安全性终点,未观察到BARC 1-5型出血事件存在差异(HR:0.439,95%CI:0.080~2.399,P=0.342)。结论: 考虑到相似的缺血事件发生率和较低的出血事件发生率,在MINOCA患者中短程DAPT可能优于长程DAPT。

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关键词 ：双联抗血小板治疗, 冠状动脉非阻塞性心肌梗死, 结局

Abstract：Objective: To investigate the effect of the duration of dual antiplatelet therapy (DAPT) on the outcome of non-obstructive coronary artery myocardial infarction (MINOCA). Methods: A total of 111 hospitalized patients examined with coronary angiography and diagnosed with MINOCA in Chengde Central Hospital from January 2016 to December 2023 were continuously enrolled. They were divided into the short-duration DAPT (1~3 months DAPT, n=59) and long-duration DAPT (3~6 months DAPT, n=52) based on the duration of DAPT. Kaplan-Meier analysis and Cox proportional hazard regression were performed to assess the effect of the duration of DAPT on the outcome of MINOCA. Results: The incidence of primary endpoints was 23.7% in the short-duration DAPT group, and 19.2% in the long-duration DAPT group, showing no significant difference (P=0.566). The Kaplan-Meier analysis also indicated comparable primary endpoints between the short-duration DAPT group and long-duration DAPT group (log-rank P=0.535). Cox regression analysis showed that in comparison to the short-duration DAPT group, a long duration of DAPT did not correlate with the reduced risk of primary endpoints (hazard ratio [HR]: 1.310, 95% confidence interval [CI]: 0.582~2.399, P=0.514). Moreover, there was no significant difference in the risk of type 1-5 Bleeding Academic Research Consortium (BARC) between the two groups (HR: 0.439, 95%CI: 0.080~2.399, P=0.342). Conclusion: Considering the similar incidence of ischemic event and lower incidence of bleeding, a short duration of DAPT may be superior to a long duration of DAPT in MINOCA patients.

Key words： Dual antiplatelet therapy Myocardial infarction with nonobstructive coronary arteries Outcome

基金资助:2023年承德市科技计划自筹经费项目,(编号:202303A019)

通讯作者: 王昆

引用本文:

王婷, 王昆, 张金龙, 魏迎丽, 邹佳莹. 双联抗血小板治疗时程对冠状动脉非阻塞性心肌梗死患者临床结局的影响[J]. 河北医学, 2025, 31(2): 264-270.
WANG Ting, et al. Effect of the Duration of Dual Antiplatelet Therapy on the Outcome of Myocardial Infarction with Non-obstructive Coronary Arteries. HeBei Med, 2025, 31(2): 264-270.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.02.015 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I2/264

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