[TCT2008]ACCEL-AMI试验

发布于:2008-10-16 18:10

ACCEL-AMI试验：三联抗血小板治疗较单用氯吡格雷可获更好的抗血小板效果

ACCEL-AMI: Triple Antiplatelet Therapy Achieved Greater Effect Than Clopidogrel Alone

（阜外心血管病医院高立建翻译）

关键点：三联抗血小板治疗可达到对血小板聚集的最大抑制作用

由西洛他唑和标准双重抗血小板治疗组成的三联抗血小板治疗与双重抗血小板治疗相比，在急性心肌梗死介入治疗患者中明显增加对血小板的抑制作用。

韩国公立庆尚大学Young-Hoon Jeong医生在2008TCT会议上公布了ACCEL-AMI试验，是一项随机临床对照试验，该试验入选了90例急性心肌梗死患者，患者随机分配到氯吡格雷标准维持剂量组（75mg/天）；氯吡格雷高维持剂量组（150mg/天）；或三联抗血小板治疗组（西洛他唑100mg/每日两次和氯吡格雷75mg/天）。

三联抗血小板治疗终点

主要终点——是通过对ADP反应的所体现的血小板的最大抑制作用，抗血小板药物治疗30天后，三联抗血小板组明显高于高剂量氯吡格雷组对血小板的抑制作用(P<.001;见图1)。

次要终点为血小板的晚期抑制作用

在ADP浓度为 5 ųmol/L (70.8%) 和20 ųmol/L (66.4%)时，三联抗血小板组明显高于其他两组对血小板的抑制作用（图2）。

标准维持剂量组与高剂量组相比，对P2Y12反应单位的抑制分别为10.6%和30.7%（P=0.003），而三联抗血小板治疗组为43%（P<0.001）
Jeong认为三联抗血小板治疗(13.3%)与标准剂量组(76.7%; P<.001)和高剂量组(56.7%; P<.001)相比较，其氯吡格雷低反应率最低。

他也提到ACCEL-AMI试验也有其局限性，如研究时间短，样本量小和对过高估计的血小板治疗偏差的校正。

总之，该研究资料也支持对三联抗血小板药物进行深入的研究。Jeong说道：这些结果为开展进一步大规模长期研究评价是否联合应用西洛他唑可更好的预防急性心肌梗死患者的血栓事件提供了合理的依据。

（来源：www.tctmd.com）

ACCEL-AMI: Triple Antiplatelet Therapy Achieved Greater Effect Than Clopidogrel Alone

Key Points:

Inhibition of maximum platelet aggregation was greatest with triple antiplatelet therapy.

By TCT Daily Staff

Triple antiplatelet therapy consisting of cilostazol added to standard dual antiplatelet therapy was associated with significantly greater platelet inhibition than dual therapy alone in patients with acute MI undergoing stent implantation.

Young-Hoon Jeong, MD, Gyeongsang National University Hospital, Jinju, South Korea, presented the findings of the prospective, randomized ACCEL-AMI trial, which included 90 patients with acute MI. Patients were assigned to one of three groups: standard maintenance dose of clopidogrel 75 mg daily; high-maintenance dose of clopidogrel 150 mg daily; or triple antiplatelet therapy with adjunctive cilostazol 100 mg twice daily plus clopidogrel 75 mg daily.

Endpoints with triple therapy

The primary endpoint – inhibition of maximal platelet aggregation(Aggmax) in response to ADP – was significantly greater in the triple antiplatelet therapy group after 30 days of therapy than with the high-maintenance and standard maintenance dose groups (P<.001; see Figure 1).

Inhibition of late platelet aggregation (Agglate), a secondary endpoint, also was significantly greater in the triple antiplatelet therapy group at both 5 ųmol/L ADP (70.8%) and 20 ųmol/L ADP (66.4%) concentrations compared with the other doses (see Figure 2).

The standard maintenance dose group had a 10.6% inhibition of P2Y12 reaction units compared with the high-maintenance dose (30.7%; P=.003) and triple antiplatelet therapy (43%; P<.001).

Triple therapy was associated with the lowest rate of clopidogrel hyporesponsiveness (13.3%) compared with the standard (76.7%; P<.001) and high-maintenance doses (56.7%; P<.001), which may suggest the possibility of reduced ischemic clinical events with adjunctive cilostazol, Jeong said.

He noted several limitations of the ACCEL-AMI trial, such as a short study period, small sample size, and correction for an overestimated antiplatelet therapy bias.

Overall, however, the data support further investigation of triple antiplatelet therapy. "These results offer a rationale for further large-scaled and long-term studies assessing whether adjunctive cilostazol provides better efficacy in prevention of thrombotic events in acute MI patients," Jeong said.

Disclosures:

Dr. Jeong reports no relevant conflicts of interest.

（source：www.tctmd.com）

来源：医心网

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