PDF(Pubmed)
Abstract：
UNASSIGNED: The optimal perioperative antithrombotic strategy for patients with acute coronary syndrome (ACS) during percutaneous coronary intervention (PCI) remains controversial.
UNASSIGNED: To determine the safety and effectiveness of bivalirudin plus ticagrelor vs bivalirudin plus clopidogrel in patients with ACS undergoing PCI in the real world.
UNASSIGNED: Between March 2016 and March 2019, 7234 patients with ACS who had undergone PCI, received bivalirudin periprocedurally, and were prescribed ticagrelor or clopidogrel were enrolled in a single-center, all-comer, modern, retrospective cohort study. Incidence rates of 12-month ischemia (cardiac death, myocardial infarction, or stroke), all-cause death, Bleeding Academic Research Consortium (BARC) type 2,3,5 bleeding, and BARC type 3,5 bleeding were compared between different groups.
UNASSIGNED: In total, 4960 patients received bivalirudin plus clopidogrel and 2274 patients received bivalirudin plus ticagrelor. Compared with bivalirudin plus clopidogrel, bivalirudin plus ticagrelor was associated with lower ischemic events (1.74% vs 2.84%; relative risk, 0.61; 95% CI, 0.41-0.91; P = .02) and stroke (0.05% vs 1.01%, P < .001) within 12 months after PCI without excessive risk of bleeding (BARC type 2,3,5 bleeding: 4.49% vs 3.76%, P = .22; BARC type 3,5 bleeding: 2.84% vs 2.02%, P = .08). The beneficial effects of bivalirudin plus ticagrelor were consistent among subgroups.
UNASSIGNED: As an initial treatment strategy, bivalirudin plus ticagrelor could reduce the 12-month risk of ischemic events compared with bivalirudin plus clopidogrel significantly without increasing the bleeding risk in ACS patients undergoing PCI.
UNASSIGNED: To determine the safety and effectiveness of bivalirudin plus ticagrelor vs bivalirudin plus clopidogrel in patients with ACS undergoing PCI in the real world.
UNASSIGNED: Between March 2016 and March 2019, 7234 patients with ACS who had undergone PCI, received bivalirudin periprocedurally, and were prescribed ticagrelor or clopidogrel were enrolled in a single-center, all-comer, modern, retrospective cohort study. Incidence rates of 12-month ischemia (cardiac death, myocardial infarction, or stroke), all-cause death, Bleeding Academic Research Consortium (BARC) type 2,3,5 bleeding, and BARC type 3,5 bleeding were compared between different groups.
UNASSIGNED: In total, 4960 patients received bivalirudin plus clopidogrel and 2274 patients received bivalirudin plus ticagrelor. Compared with bivalirudin plus clopidogrel, bivalirudin plus ticagrelor was associated with lower ischemic events (1.74% vs 2.84%; relative risk, 0.61; 95% CI, 0.41-0.91; P = .02) and stroke (0.05% vs 1.01%, P < .001) within 12 months after PCI without excessive risk of bleeding (BARC type 2,3,5 bleeding: 4.49% vs 3.76%, P = .22; BARC type 3,5 bleeding: 2.84% vs 2.02%, P = .08). The beneficial effects of bivalirudin plus ticagrelor were consistent among subgroups.
UNASSIGNED: As an initial treatment strategy, bivalirudin plus ticagrelor could reduce the 12-month risk of ischemic events compared with bivalirudin plus clopidogrel significantly without increasing the bleeding risk in ACS patients undergoing PCI.
摘要：
急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）期间的最佳围手术期抗血栓策略仍存在争议。
■在真实世界中确定比伐卢定联合替格瑞洛与比伐卢定联合氯吡格雷治疗ACS患者的安全性和有效性。
■在2016年3月至2019年3月之间，7234名接受PCI的ACS患者在围手术期接受了比伐卢定，服用替格瑞洛或氯吡格雷的患者纳入单中心，所有人，现代,回顾性队列研究。12个月缺血的发生率（心脏死亡，心肌梗塞,或中风)，全因死亡,出血学术研究联盟（BARC）2,3,5型出血，比较不同组之间的BARC3,5型出血情况。
■总共，4960例患者接受比伐卢定联合氯吡格雷治疗，2274例患者接受比伐卢定联合替格瑞洛治疗。与比伐卢定加氯吡格雷相比，比伐卢定联合替格瑞洛与较低的缺血事件相关(1.74%vs2.84%;相对危险度,0.61；95%CI，0.41-0.91；P=.02）和卒中（0.05%vs1.01%，P<.001）PCI术后12个月内无过度出血风险（BARC2,3,5型出血：4.49％vs3.76％，P=.22；BARC3,5型出血：2.84％vs2.02％，P=.08）。比伐卢定联合替格瑞洛的有益效果在亚组之间是一致的。
■作为初始治疗策略，在接受PCI的ACS患者中,与比伐卢定联合氯吡格雷相比,比伐卢定联合替格瑞洛可显著降低12个月缺血事件的风险,而不会增加出血风险.
■在真实世界中确定比伐卢定联合替格瑞洛与比伐卢定联合氯吡格雷治疗ACS患者的安全性和有效性。
■在2016年3月至2019年3月之间，7234名接受PCI的ACS患者在围手术期接受了比伐卢定，服用替格瑞洛或氯吡格雷的患者纳入单中心，所有人，现代,回顾性队列研究。12个月缺血的发生率（心脏死亡，心肌梗塞,或中风)，全因死亡,出血学术研究联盟（BARC）2,3,5型出血，比较不同组之间的BARC3,5型出血情况。
■总共，4960例患者接受比伐卢定联合氯吡格雷治疗，2274例患者接受比伐卢定联合替格瑞洛治疗。与比伐卢定加氯吡格雷相比，比伐卢定联合替格瑞洛与较低的缺血事件相关(1.74%vs2.84%;相对危险度,0.61；95%CI，0.41-0.91；P=.02）和卒中（0.05%vs1.01%，P<.001）PCI术后12个月内无过度出血风险（BARC2,3,5型出血：4.49％vs3.76％，P=.22；BARC3,5型出血：2.84％vs2.02％，P=.08）。比伐卢定联合替格瑞洛的有益效果在亚组之间是一致的。
■作为初始治疗策略，在接受PCI的ACS患者中,与比伐卢定联合氯吡格雷相比,比伐卢定联合替格瑞洛可显著降低12个月缺血事件的风险,而不会增加出血风险.
