| Objective To describe the present situation and adverse clinical outcome of dual antiplatelet therapy after PCI in patients with coronary heart disease in plateau.Methods Patients with coronary heart disease who received PCI for the first time were consecutively included in the Highland Cardiology Department of the People’s Hospital of Tibet Autonomous Region from January 2018 to December 2020.At 3,6,12 and 18 months after PCI,the types and time of postoperative antiplatelet drugs and the occurrence of adverse clinical outcomes were conducted to record by outpatient and telephone follow-up.Results A total of 320 patients were included and followed up,with a follow-up rate of 98.8%.Acute ST-segment elevation myocardial infarction was predominant(217 cases,68%).Patients mainly involved anterior descending rami,and an average of 1.27 stents implanted.All patients were treated with dual antiplatelet therapy at discharge,but the use rate of β-blockers only reached 59.4%,and the use rate of ACEI/ARB/ARNI was 80.3%,which was the highest in stable angina pectoris and acute ST-segment elevation myocardial infarction.During the follow-up period,the discontinuation rate of aspirin mainly occurred12 months after PCI,which was significantly higher than the discontinuation rate from March to June and June to December(12.6%vs.3.7%vs.2.8%,P<0.001).Similarly,the discontinuation rate of clopidogrel and ticagrelor occurred at most 12 months after PCI,which was higher than other time periods,with statistical significance(P<0.001).During follow-up,a total of 23 patients(7.2%)developed stent stenosis,26 patients(8.1%)developed recurrent myocardial infarction,49 patients(15.3%)developed heart failure,5patients(1.5%)developed stroke,and 13 patients(4.1%)developed BARC3-5 hemorrhage,Cardiac death occurred in 9 patients(2.8%).The incidence of adverse clinical events increased with the extension of time after PCI.Coronary heart disease patients with a history of diabetes mellitus were more likely to develop in-stent stenosis(14.5%vs.5.4%,P=0.013),and coronary heart disease patients with a history of hypertension were more likely to develop heart failure(19.4%vs.11.0%,P=0.036).The incidence of recurrent myocardial infarction and heart failure in patients with single-vessel disease was lower than that in patients with double-vessel disease and three-vessel disease(2.1%vs.13.3%vs.12%,P<0.05;12.9% vs.17.1% vs.17.3%,P<0.05);The incidence of stent stenosis,repeat myocardial infarction,heart failure,hemorrhage and death in patients with coronary heart disease implanted with 3 stents was significantly higher than that in patients with coronary heart disease implanted with 1 stent and 2 stents,but there was no statistical difference(P>0.05).The incidences of repeat myocardial infarction and stroke were lower in patients with coronary heart disease who stopped medication within 12 months after PCI than those stopped medication 12 months after PCI(14.8% vs.6.1% and 5.4% vs.0.4%,p<0.05),The incidences of ischemic events and Overall adverse clinical outcome in patients who stopped medication within 12 months after PCI were significantly higher than those stopped medication after 12 months after PCI.Smoking,left ventricular ejection fraction on admission,white blood cell count,BNP were clearly correlated with overall adverse clinical outcomes.Conclusion At discharge,patients with coronary heart disease were given dual antiplatelet therapy(aspirin combined with clopidogrel or aspirin combined with ticagrelor)after PCI.Discontinuation of dual antiplatelet therapy in patients with coronary heart disease after PCI mostly occurred 12 months later,and the rate of discontinuation 3 months after PCI was also not negligible,and the occurrence of adverse clinical outcomes also increased with the extension of time after PCI,and was related to patients’ smoking,previous history of diabetes,hypertension,history of cerebrovascular disease,etc. |
