Therapeutic Effects of Triple Antiplatelet Therapy in Elderly Female Patients with Diabetes and Acute Myocardial Infarction

Abstract Background Dual antiplatelet therapy (DAPT) is the cornerstone treatment of acute myocardial infarction (AMI). Objective The present study aimed to investigate the efficacy and safety of triple antiplatelet therapy (TAPT) in elderly female patients with diabetes and ST segment elevation myocardial infarction (STEMI), who had undergone percutaneous coronary intervention (PCI). Methods We designed a randomized, single-blind study. Control group A (97 elderly male patients with diabetes and STEMI, whose CRUSADE scores were < 30) received aspirin, ticagrelor, and tirofiban. A total of 162 elderly female patients with diabetes and STEMI were randomly divided into two groups according to CRUSADE score. Group B (69 patients with CRUSADE score > 31) received aspirin and ticagrelor. Group C (93 patients with CRUSADE score < 30) received aspirin, ticagrelor and tirofiban. P values < 0.05 were considered statistically significant. Results Compared to the findings in group A, post-PCI Thrombolysis in Myocardial Infarction (TIMI) grade 3 blood flow and TIMI myocardial perfusion grade 3 were significantly less prevalent in group B (p < 0.05). When compared to groups A and C, the incidence of major adverse complications was significantly higher in group B (p < 0.05). Conclusion TAPT could effectively reduce the incidence of major complications in elderly female patients with diabetes and STEMI. However, close attention should be paid to hemorrhage in patients receiving TAPT. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

【摘要】背景 双联抗血小板治疗（Dual antiplatelet therapy, DAPT）是急性心肌梗死（acute myocardial infarction, AMI）的核心治疗方案。目的 本研究旨在探讨三联抗血小板治疗（triple antiplatelet therapy, TAPT）在合并糖尿病的老年女性ST段抬高型心肌梗死（ST segment elevation myocardial infarction, STEMI）且已接受经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）的患者中的疗效与安全性。方法 本研究为随机单盲试验。对照组A纳入97例合并糖尿病的老年男性STEMI患者，其CRUSADE评分低于30分，予以阿司匹林、替格瑞洛及替罗非班治疗。共计162例合并糖尿病的老年女性STEMI患者依据CRUSADE评分随机分为两组：B组（69例，CRUSADE评分>31）仅接受阿司匹林与替格瑞洛治疗；C组（93例，CRUSADE评分<30）接受阿司匹林、替格瑞洛及替罗非班治疗。以P值<0.05作为差异具有统计学意义的判定标准。结果 与A组相比，B组患者PCI术后心肌梗死溶栓治疗（Thrombolysis in Myocardial Infarction, TIMI）3级血流及TIMI心肌灌注分级3级的发生率显著更低（P<0.05）。相较于A组与C组，B组患者的主要不良并发症发生率显著更高（P<0.05）。结论 三联抗血小板治疗可有效降低合并糖尿病的老年女性STEMI患者的主要并发症发生率，但需密切关注接受TAPT治疗患者的出血风险。本研究刊载于《Arq Bras Cardiol》2020年；[在线先行发表]，页码0-0。