氯吡格雷在心肌梗死中的应用：CLARITY-TIMI 28研究和COMMIT研究PPT课件.ppt

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1、BackgroundFibrinolyticRxinSTEMIislimitedbyinadequatereperfusionand/orreocclusionin~25%ofpts.Anoccludedinfarct-relatedarteryisassociatedwithadoublingoflong-termmortality.08162432404805101520OccludedPatentWeeksMortality(%)Dalen,Gore,Braunwaldetal.AmJCardiol1988;62:179.Evidencefortheopenar

2、teryhypothesis:TIMI1ClopidogrelOralantiplateletmedicationthatblocksADPreceptorandworkssynergisticallywithaspirinModifiedfromSchafer.AmJMed1996;101:199-209.StudyDesignofCLARITYTrialDouble-blind,randomized,placebo-controlledtrialin3491patients,age18-75yearswithSTEMI<12hoursFibrinolytic,A

3、SA,heparinClopidogrel300mg+75mgqdCoronaryangiogram(2-8days)Primaryendpoint:Occludedartery(TIMIFlowGrade0/1)orD/MIbytimeofangiorandomizePlaceboStudydrug30-dayclinicalfollow-upOpen-labelclopidogrelperMDinbothgroupsAspresentedbyDrMarcSabatinetoACC2005Sabatineetal.NEnglJMed2005;352:1179-

4、1189.InitialTherapyCharacteristicClopidogrelPlaceboFibrin-specificlytic69%69%Non-fibrinspecificlytic31%31%Initialaspirin99%99%UFH46%46%LMWH30%29%Both5%5%Neither19%20%Beta-blockers89%89%Statins80%81%ACEIorARB73%72%Sabatineetal.NEnglJMed2005;352:1179-1189.InterventionsParameterClopidogrel

5、PlaceboSxonsettofibrinolytic2.7hrs2.6hrsFibrinolytictostudydrug10mins10minsMedian#dosesofstudymed44Angiography93.9%94.2%Studydrugtoangiography3.5days3.5daysCoronaryrevascularization62.8%62.4%PCI57.2%56.6%CABG5.9%6.0%Sabatineetal.NEnglJMed2005;352:1179-1189.PrimaryEndpoint:OccludedArtery

6、(orD/MIthruAngio/HD)PlaceboClopidogrelP=0.00000036Oddsratio0.64(95%CI0.53-0.76)1.00.40.60.81.21.6ClopidogrelbetterPlacebobettern=1752n=173936%OddsreductionSabatineetal.NEnglJMed2005;352:1179-1189.Subgroups–PrimaryEndpoint1.00.40.60.81.21.6ClopidogrelbetterPlacebobetterCharacteristicOdds

7、ratio(95%CI)Allinteractionsnon-significantOddsEventrates(%)reductionClopidogrelPlaceboOVERALL36%15.021.7Age<65yr42%13.221.065yr22%19.023.1GenderMale35%14.520.8Female38%16.924.7InfarctlocationAnterior33%15.020.7Non-anterior38%15.022.2FibrinolyticFibrin-specific31%14.720.1Non-fi