MATCH中文1演示教学.ppt

波立维?和阿司匹林针对有缺血性事件危险性患者的研究中（CAPRIE），对波立维?和阿司匹林进行了比较，这是一个以各种动脉粥样硬化疾病患者为对象的随机、双盲研究。 这项研究的依据是这些患者具有发生各种动脉血栓事件（心肌梗死[MI]，缺血性中风[IS]和血管性死亡）的危险性，抗血血小板药物对动脉血栓的不同临床表现有相同的疗效。 入选患者有以下三个条件之一（近期IS，近期MI，或外周动脉疾病），依据为近期有间歇性跛行或者有动脉介入史。无论患者是否终止用药，都随访1到3年。主要终点是IS，MI或血管性死亡的复合。 Reference: 1. CAPRIE Steering Committee. Lancet 1996; 348: 1329–39. 波立维?比ASA更有效地降低心肌梗死、缺血性中风或血管性死亡的综合危险性（相对危险度降低8.7%，p＝0.043）1 这种改善作用是在ASA基础上进一步加强（先前报道ASA能使中风、MI和血管性死亡发生的危险性下降25%）2 波立维?和ASA的累积事件发生率曲线在随访早期即开始分离，并持续整个3年的随访期。1 在CAPRIE研究中，波立维? 75mg/天是和ASA具有相似的良好耐受性，且与年龄，性别和种族无关。1 Reference: CAPRIE Steering Committee. Lancet 1996; 348: 1329–1339. Antiplatelet Trialists Collaboration. BMJ 2002; 324: 71–86. In CAPRIE,1 8,854 patients had a prior history of previous vascular disease, and of these 4,496 had a history of a major acute event – an MI or stroke.1 The 3-year cumulative rate per 1,000 patients was reduced in the clopidogrel group versus the ASA group by 34 in patients with a prior history of a major acute event, and by 28 in those with a prior history of any ischemic event compared with 11 in the overall population.1,2 The benefits of clopidogrel over ASA were amplified in the higher vascular risk group.3 References CAPRIE Steering Committee. Lancet 1996; 348: 1329–1339. Jarvis B, et al. Drugs 2000; 60: 34–77. Hacke W, et al. Eur Heart J 1999; 20: 666. In CAPRIE, 3,866 patients had co-existing diabetes.1 These patients are at higher risk of MI, IS, vascular death or hospitalization for ischemic events/bleeding (17.7% diabetic versus 13.7% non-diabetic in the ASA group; 15.6% diabetic versus 12.6% non-diabetic in the clopidogrel group).2 The number of events prevented was reduced in the clopidogrel group versus the ASA group by 38 in patients receiving insulin at baseline and 21 in all patients with a history of diabetes compared with 11 in the overall CAPRIE population. The benefits of clopidogrel over ASA were amplified in the higher risk, insulin-dependent patients. References Bhatt DL, et al.