TUhjnbcbe - 2021/8/22 16:19:00
TicagrelororClopidogrelAfteranAcuteCoronarySyndromeintheElderly:APropensityScoreMatchingAnalysisfrom16,PatientsTreatedwithPCIIncludedinTwoLargeMultinationalRegistriesCardiovasc?Drugs?TherOriginalArticleEarlyRecent,July05,./s---y本文由“天纳”临床学术信息人工智能系统自动翻译点击文末“阅读原文”下载本文PDFPurposeHigherriskofbleedingwithticagreloroverclopidogrelinelderlypatientswithacutecoronarysyndrome(ACS)whounderwentpercutaneouscoronaryintervention(PCI)hasbeensuggested.Weassessedtheincidenceofmajorbleedings(MB),reinfarction(re-MI),andall-causedeathtoevaluatesafetyandefficacyofticagrelorversusclopidogrelinsuchpopulation.在接受经皮冠状动脉介入治疗（PCI）的老年急性冠脉综合征（ACS）患者中，替卡格雷较氯吡格雷更易出血。我们评估了主要出血（MB）、再梗塞（reMI）和全因死亡的发生率，以评估替卡格雷与氯吡格雷在此类人群中的安全性和有效性。MethodsReal-worldregistriesRENAMIandBleeMACSweremerged.Thepooledcohortwasdividedintotwogroups,clopidogrelversusticagrelor.Statisticalanalysisconsideredpatients75versus≥75?yearsold.EndpointswereBARC3–5?MB,re-MI,andall-causedeathat1-yearfollow-up.Thestudyincluded16,patients(13,??75and?≥?75?years).Ticagrelorwasunderusedinelderlypatients(16.3%versus20.8%,P??0.).Usingpropensityscorematching(PSM),twotreatmentgroupsofpatientswereincludedinthefinalanalysis.现实世界的注册中心RENAMI和BleeMACS合并了。这组患者被分为两组，氯吡格雷组和替卡格雷组。统计分析考虑75岁以下患者与≥75?岁。终点为barc3-5?1年随访时MB、re-MI和全因死亡。这项研究包括16名患者（13人）??75和?≥?75?年）。替卡格雷在老年患者中使用不足（16.3%对20.8%，P??0.).采用倾向评分匹配法（PSM），将两个治疗组例患者纳入最终分析。ResultsTicagrelorwasabletopreventre-MI(hazardratio
,0.31;95%confidenceinterval[CI],0.2–0.6;P??0.)andall-causedeath(HR,0.60;95%CI,0.4–0.9;P?=?0.)irrespectiveofage.Inpatients≥75?years,ticagrelorreducedall-causedeath(HR,0.32;95%CI,0.1–0.8;P?=?0.)andre-MI(HR,0.25;95%CI,0.1–1.1,P?=?0.).Moreover,evenwiththelimitofthelownumberofevents,ticagrelordidnotsignificantlyincreasetheincidenceofMB(HR,1.49;95%CI,0.70–3.0;P?=?0.).AtmultipleCoxregression,age(HR,1.03;95%CI,1.02–1.05;P??0.)resultedanindependentriskfactorforbleeding.替卡格雷能预防再发性心肌梗死（危险比
，0.31；95%置信区间[CI]，0.2–0.6；P??0.）和全因死亡（HR，0.60；95%可信区间，0.4-0.9；P?=?0.）不考虑年龄。在病人中≥75?三年后，替卡格雷降低了全因死亡率（HR，0.32；95%可信区间，0.1-0.8；P?=?0.）和re-MI（HR，0.25；95%可信区间，0.1–1.1，P?=?0.).此外，即使在低事件数的限制下，替卡格雷也没有显著增加MB的发生率（HR，1.49；95%可信区间，0.70-3.0；P?=?0.).多因素Cox回归分析，年龄（HR，1.03；95%可信区间，1.02-1.05；P??0.）为出血的独立危险因素。ConclusionInourstudy,reflectingtheresultsfromtwolargeretrospective,real-worldregistries,TicagrelordidnotsignificantlyincreaseMB