Background:

Patients on dual antiplatelet therapy following percutaneous coronary intervention often have indications for concomitant oral anticoagulation, known as triple antithrombotic therapy. Majority of literature evaluating triple antithrombotic therapy fails to adequately represent patients with ST-elevation myocardial infarction and those prescribed potent P2Y12 inhibitors, ticagrelor or prasugrel. The purpose of this study was to evaluate the safety and efficacy of triple antithrombotic regimens containing ticagrelor or prasugrel versus clopidogrel after percutaneous coronary intervention in the setting of ST-elevation myocardial infarction.

Methods:

This was a single-center, retrospective cohort trial. The primary endpoint was net adverse clinical event, defined as the primary efficacy endpoint of death, myocardial infarction, or cerebrovascular accident and the primary safety endpoint of any bleeding event.

Results:

Between October 2017 and October 2019, a total of 65 patients with ST-elevation myocardial infarction were initiated on triple therapy. Forty-six patients were included in the primary analysis, of which 26 were discharged on triple antithrombotic therapy with clopidogrel and 20 discharged on potent P2Y12 inhibitors (ticagrelor or prasugrel). The primary endpoint occurred in 27% of the clopidogrel group and 40% of the potent P2Y12 inhibitor group (P = 0.35). Bleeding occurred in 23% of the clopidogrel group and 35% of the potent P2Y12 inhibitor group (P = 0.37).

Conclusions:

This small cohort study suggests, in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention, the net adverse clinical event rate does not differ between clopidogrel and potent P2Y12 inhibitors in the setting of triple antithrombotic therapy. The results of this exploratory analysis warrant confirmation in a larger, randomized study.

中文翻译：

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ST 段抬高型心肌梗死经皮冠状动脉介入治疗后替格瑞洛或普拉格雷三联疗法与氯吡格雷三联疗法的安全性和有效性

背景：

经皮冠状动脉介入治疗后接受双重抗血小板治疗的患者通常有同时口服抗凝药物的适应症，称为三联抗血栓治疗。大多数评估三联抗血栓治疗的文献未能充分代表 ST 段抬高型心肌梗死患者和处方强效 P2Y12 抑制剂替格瑞洛或普拉格雷的患者。本研究的目的是评估在 ST 段抬高型心肌梗死的情况下，经皮冠状动脉介入治疗后含有替格瑞洛或普拉格雷的三联抗血栓方案与氯吡格雷的安全性和有效性。

方法：

这是一项单中心、回顾性队列试验。主要终点是净不良临床事件，定义为死亡、心肌梗死或脑血管意外的主要疗效终点和任何出血事件的主要安全终点。

结果：

2017 年 10 月至 2019 年 10 月期间，共有 65 例 ST 段抬高心肌梗死患者开始接受三联疗法。46 名患者被纳入初步分析，其中 26 名患者出院后接受氯吡格雷三联抗血栓治疗，20 名患者使用强效 P2Y12 抑制剂（替格瑞洛或普拉格雷）出院。主要终点发生在 27% 的氯吡格雷组和 40% 的强效 P2Y12 抑制剂组（P = 0.35）。23% 的氯吡格雷组和 35% 的强效 P2Y12 抑制剂组发生出血（P = 0.37）。

结论：

这项小型队列研究表明，在接受经皮冠状动脉介入治疗的 ST 段抬高心肌梗死患者中，在三联抗血栓治疗的情况下，氯吡格雷和强效 P2Y12 抑制剂之间的净不良临床事件发生率没有差异。这项探索性分析的结果需要在更大的随机研究中得到证实。