Objective To compare the effects of clopidogrel combined with dihydropyridine calcium-channel blockers (CCBs) or nondihydropyridine CCBs on coronary artery disease (CAD) in elderly patients.Methods The study cohort was defined as all patients 5≥60 years old hospitalized for CAD with the prescription of clopidogrel between January 2001 and february 2011.The primary endpoint was death of all causes,and the secondary endpoints were nonfatal myocardial infarction (MI),hospitalization for unstable angina,stroke,transient ischemic attack,or repeat revascularizarion (PCI or coronary artery bypass graft).Results A total of 1021 patients were enrolled,among whom 402 patients were prescribed with clopidogrel and 619 with clopidogrel combined with CCB (dihydropyridine in 547 and nondihydropyridine in 72).In clopidogrel group and clopidogrel with CCB group,the incidence density of death was 50.55 per thousand and 42.02 per thousand,respectively.The crude RR was 0.83 (95% CI: 0.55-1.26),and the multivariable-adjusted RR was 0.47 (95% CI: 0.14-1.6),showing no statistical significance in the rate of deaths of call causes between the two groups (P>0.05); the incidence density of composite thromboembolic events showed no significant difference between the two groups,either (P>0.05).After weighting of the propensity score,the patients with clopidogrel coadministered with nondihydropyridine CCB showed a significant increase in composite thromboembolic events than those taking dihydropyridine CCB,with a SMRW-adjusted OR of 1.97 (95%: 1.2-3.23,P=0.007).No significant difference was observed in death or composite thromboembolic events between Pgp-inhibiting CCBs and non-Pgp-inhibiting CCBs.Conclusion Compared with clopidogrel without CCB,clopidogrel with CCB does not increase the mortality or composite thromboembolic events in elderly CAD patients,but clopidogrel combined with nondihydropyridine CCB is associated with significantly increased composite thromboembolic events in comparison with dihydropyridine CCB.%目的 比较老年冠心病患者单用氯吡格雷与氯吡格雷联用钙拮抗剂(CCB)的疗效.方法 选自2000年1月～2011年2月有完整住院资料及门诊随访记录,服用氯吡格雷的老年冠心病患者1021名,其中单用氯吡格雷402例,氯吡格雷联用CCB 619例,其中二氢吡啶类钙拮抗剂547例,非二氢吡啶类钙拮抗剂72例；P糖蛋白(Pgp)抑制剂的钙拮抗剂患者357例,非PgP抑制剂的CCB患者262例.研究主要终点为随访期内全因死亡,次要终点为心绞痛再入院,心梗再入院,血管再通术(PCI或CABG),脑卒中,TIA.结果 氯吡格雷组和联用CCB组发病密度(全因死亡)分别是50.55/1000、42.02/1000,粗RR 0.83 (95％ CI:0.55～1.26),调整RR 0.47 (95％CI:0.14～1.6),两组全因死亡率无显著差异(P＞0.05)；终点事件发生率比较也无显著差异(P＞0.05).对所有混杂因素进行倾向评分加权后,非二氢吡啶类CCB比二氢吡啶类CCB增加缺血性心脑血管事件风险,SMRW调整OR=1.97( 95％:1.2～3.23),P=0.007；氯吡格雷联用CCB组与单用氯吡格雷组加权前后全因死亡率及终点事件比较,差异无统计学意义.不同代谢途径CCB加权前后全因死亡率比较无显著差异(P＞0.05).结论 老年冠心病患者联用氯吡格雷及CCB治疗不增加全因死亡及缺血性心脑血管事件的发生,不同代谢途径CCB之间死亡率无明显差异,非二氢吡啶类CCB与氯吡格雷联用时比二氢吡啶类CCB致缺血性心脑血管终点事件的风险更高.
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