2024 年第 6 期 第 0 卷

既往高血压脑出血经皮冠状动脉介入治疗患者延长双联抗血小板治疗的预后研究

Prognostic study of extended dual antiplatelet therapy in patients with previous hypertensive cerebral hemorrhage undergoing percutaneous coronary intervention

作者：乔曼丽1马立萍1苏崇弘1温雪2

英文作者：Qiao Manli1 Ma Liping1 Su Chonghong1 Wen Xue2

单位：1首都医科大学附属北京安贞医院全科医疗科，北京100029；2北京市通州区宋庄镇徐辛庄卫生服务中心，北京101100

英文单位：1Department of General Practice Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Community Health Service Center in Xuxinzhuang Village Songzhuang Town Tongzhou District Beijing 101100 China

关键词：高血压脑出血；经皮冠状动脉介入；主要出血；双联抗血小板治疗

英文关键词：Hypertensivecerebralhemorrhage;Percutaneouscoronaryintervention;Majorbleeding;Dualantiplatelettherapy

• 摘要：

• 目的 探讨既往高血压脑出血经皮冠状动脉介入(PCI)治疗患者延长双联抗血小板治疗（DAPT）的风险和获益。方法 本研究为观察性临床研究，纳入2005年1月至2014年12月于首都医科大学附属北京安贞医院住院有高血压脑出血病史的PCI患者128例作为观察组，有高血压但无脑出血病史的PCI患者153例作为对照组。所有患者PCI术后均服用阿司匹林100 mg/d和氯吡格雷75 mg/d治疗，随访时间为12～48个月。疗效终点为主要不良心脑血管事件(MACCE)，安全性终点为脑出血和主要出血。DAPT时间＞12个月为延长DAPT，DAPT时间≤12个月为未延长DAPT。对影响终点事件的因素进行单因素及多因素Cox回归分析。结果 既往高血压脑出血病史（P=0.029）、急性心肌梗死（P=0.027）是高血压PCI患者MACCE的独立危险因素,而延长DAPT是其独立保护因素(风险比=0.351，P＜0.001)。亚组分析中，延长DAPT增加既往高血压脑出血PCI患者主要出血风险（风险比=6.650，P=0.036），但未降低MACCE风险（P=0.349）。延长DAPT未增加既往高血压PCI患者主要出血风险（P=0.538），但能明显降低MACCE风险（风险比=0.356，P=0.044）。结论 延长DAPT增加既往高血压脑出血病史的PCI患者主要出血风险，DAPT需控制在12个月之内。延长DAPT在降低既往高血压PCI患者MACCE风险的同时，没有增加其主要出血的风险，建议适当延长DAPT时间。

• Objective To investigate the risks and benefits of extended dual antiplatelet therapy (DAPT) in patients with previous hypertensive cerebral hemorrhage undergoing percutaneous coronary intervention (PCI). Methods This study was an observational clinical study. A total of 128 patients with a history of hypertensive cerebral hemorrhage who underwent PCI in Beijing Anzhen Hospital, Capital Medical University from January 2005 to December 2014 were enrolled as observation group, and 153 patients with hypertension but no history of cerebral hemorrhage were enrolled as control group. All patients were administered aspirin 100 mg/d and clopidogrel 75 mg/d after PCI, and the follow-up ranged from 12 to 48 months. The efficacy endpoint was major adverse cardiovascular and cerebrovascular events(MACCE),while the safety endpoint were cerebral hemorrhage and major bleeding. The duration of DAPT >12 months was defined as extended DAPT, and the duration of DAPT ≤12 months was defined as non-extended DAPT. Univariate and multivariate Cox regression analysis were used to analyze the factors affecting the endpoint events. Results Previous history of hypertensive cerebral hemorrhage （P=0.029） and acute myocardial infarction （P=0.027） were independent risk factors for MACCE in hypertensive patients undergoing PCI, while extended DAPT (hazard ratio=0.351, P＜0.001) was an independent protective factor. In subgroup analysis, extended DAPT increased the risk of major bleeding in PCI patients with previous hypertensive cerebral hemorrhage (hazard ratio=6.650, P=0.036), but did not decrease the risk of MACCE (P=0.349). Extended DAPT did not increase the risk of major bleeding in PCI patients with previous hypertensive (P=0.538), but significantly reduced the risk of MACCE (hazard ratio=0.356, P=0.044). Conclusions  Extended DAPT increases the risk of major bleeding in PCI patients with a history of hypertensive cerebral hemorrhage, and DAPT should be controlled within 12 months. Extended DAPT can reduce the risk of MACCE and does not increase the risk of major bleeding in patients with hypertension before PCI. It is recommended to extend the DAPT appropriately.