目的 观察经皮冠状动脉(冠脉)介入治疗的老年冠心病合并心房颤动(房颤)患者不同抗凝治疗方案的预后. 方法 回顾性分析,选择北京安贞医院心内科自2013年1月至2015年12月收治的冠心病介入治疗合并房颤患者272例,其中男性121例,女151例,平均年龄为(67.1±5.2)岁.根据抗凝治疗方案分为双联抗血小板抗栓组(阿司匹林十氯吡格雷,DT组)175例;三联抗栓组(华法林十阿司匹林十氯吡格雷,TT组)97例.随访1年,评估两组患者的大出血风险和不良心脑血管事件风险. 结果 随访1年DT组、TT组大出血发生率0.6％(1例)和5.2％(5例),差异有统计学意义(x 2=5.92,P=0.01).随访1年,1例患者(DT组)发生支架内血栓,52例(19.1％)患者出现再次心肌梗死,45例(16.5％)患者行再次血运重建,10例(3.7％)患者死亡,135例(49.6％)患者发生不良心脑血管事件,两组比较差异无统计学意义(均P＞0.05);27例(9.9％)患者发生脑卒中,两组比较差异无统计学意义(P＞0.05),但DT组有增加脑卒中的发生风险. 结论 老年房颤患者冠脉介入术后应用三联抗栓治疗增加大出血的风险,并未显著降低不良心脑血管事件发生率.双联抗血小板抗栓方案有增加房颤引发缺血性脑卒中的风险.%Objective To evaluate the short-term safety,efficacy and prognosis of different antithrombotic therapy regimens in elderly patients with atrial fibrillation after coronary artery stenting.Methods A total of 272 atrial fibrillation patients with 121 males and a mean age of(67.1 ±5.2)years undergoing coronary artery stenting in our hospital from January 2013 to December 2015 were retrospectively analyzed and rondomized into two antithrombotic therapy regimens:a dual antiplatelet therapy with aspirin and clopidogrel(DT group,n=175)and a triple antithrombotic therapy with warfarin,aspirin and clopidogrel(TT group,n=97).The one-year risk of major bleeding and major adverse cardiac and cerebrovascular event (MACCE) were compared between two groups.Results After one year follow-up,the rate of major bleeding was lower in the DT group (0.6％,n=1)than in the TT group(5.2％,n=5)(x2 =5.92,P =0.01).Nevertheless,the rates of MACCE showed no statistical difference between two groups (all P ＞ 0.05).No statistically significant differences were found between DT group(n=175)and TT group(n=97)in six therapeutic efficacy indexes as the follow[n(％)in DT vs.n(％)in TT]:in in-stent thrombosis[1 (0.6)in DT vs.0 (0.0) in TT],in myocardial infarction relapse [35 (20.0) in DT vs.17 (17.5) in TT],in revascularization once more[28(16.0)in DT vs.17(17.5)in TT],in death[7(4.0)in DT vs.3(3.1)in TT],in adverse cardiac cerebrovascular events[90 (51.4) in DT vs.45 (46.4) in TT],and in ischemic stroke[19(10.9) in DT vs.8 (8.2) in TT] (all P ＞ 0.05).However,the rate of atrial fibrillationinduced ischemic stroke may be increased in patients treated with DT of aspirin and clopidogrel as compared with TT of warfarin,aspirin and clopidogrel.Conclusions For atrial fibrillation after coronary artery stenting,triple antithrombotic treatment can lead to increased risks for major bleeding with similar rate of MACCE to dual antiplatelet therapy,but dual antiplatelet therapy may result in the raised rate of atrial fibrillation induced ischemic stroke.
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