Name: 2026年2月13日 本週心臟學回顧！ (Feb 13 2026 This Week in Cardiology)
Uploaded: 2026-02-19T22:15:38.000Z
Duration: 29 min 40 s

You're listening to this Week in Cardiology from theheart.org, medscape Cardiology.

您正在收聽來自 theheart.org, medscape Cardiology 的「心臟科本週大事」。

情態副詞

This podcast is intended for healthcare professionals only.

本播客僅供醫療專業人士收聽。

Any views expressed are the presenter's own and do not necessarily reflect the views of WebMD or Medscape.

此處表達的觀點僅為講者個人意見，不一定代表 WebMD 或 Medscape 的立場。

Hi everyone, this is John Mandrola from theheart.org Medscape Cardiology and this is this Week in Cardiology for February 14, 2026.

大家好，我是 John Mandrola，來自 theheart.org Medscape Cardiology，這是 2026 年 2 月 14 日的心臟科本週大事。

This week Ticagulore versus Prosugrel, a new left atrial appendage closure device, PFAAF ablation results, lifestyle intervention in afib, the term provider versus doctor and coffee.

本週內容有 Ticagulore 與 Prosugrel 的比較、新型左心耳閉合術裝置、PFAAF 燒灼術結果、心房顫動的生活方式幹預、provider 與 doctor 的用語差異，以及 coffee。

JAMA Cardiology is published Tuxedo 2 trial of Ticagula versus Prosugrel as the second antiplatelet drug with aspirin after coronary stenting in patients who have diabetes and multivesal disease.

JAMA Cardiology 發表了 Tuxedo 2 試驗，該試驗比較了在接受冠狀動脈支架置入術後，患有糖尿病及多血管疾病的病患中，使用 Ticagula 或 Prosugrel 作為第二種抗血小板藥物與阿斯匹靈併用的情況。

Now one twist on the RCT of 1,800 patients was that it was done in India.

這項針對 1,800 名病患的 RCT 有一個特別之處，那就是它是在 India 進行的。

Now as a neutral Martian, I like the study question because I see much more Ticagrelar used in Procugrel.

身為一個中立的 Martian，我喜歡這個研究問題，因為我看到 Ticagrelar 的使用遠比 Procugrel 來得多。

But the German government funded ISAR React 5 trial was highly significant 36% higher rate of death, MI and stroke with Ticagulore versus ProCugrel.

但由德國政府資助的 ISAR React 5 試驗結果非常顯著，Ticagulore 相較於 ProCugrel，在死亡、心肌梗塞及中風的發生率高出 36%。

That trial was published in 2019 seven years ago.

這項試驗發表於 2019 年，也就是七年前。

Of course I get the fact that it's more complex logistics to give with Prosogril, but gee whiz.

當然，我知道搭配 Prosugrel 的後勤作業會更複雜，但這也太誇張了吧。

As I have said many times, it shocks me that Ticagulor use is so much greater than Prosegril now.

我說過很多次了，Ticagrelar 的使用量遠高於 Prosugrel，這點讓我很震驚。

But that's not the only knock on Ticagulor right in play doh, which was Ticagulor versus Clopidogrel.

但這不是 Ticagrelar 在現今 play doh 中唯一的缺點，那就是 Ticagrelar 對比 Clopidogrel。

The top line was that Ticagulor reduced the primary endpoint of CV, death, MI and stroke by 16%.

主要結果是 Ticagrelar 將心血管事件、死亡、心肌梗塞和中風等主要終點降低了 16%。

But the Plato trial has legendary criticisms and weaknesses right in US patients, there were more deaths in the Ticagular group compared to clopidogrel, the opposite of what was seen globally.

但 Plato 試驗有其傳奇性的批評和弱點，在美國病患身上，Ticagrelar 組的死亡人數比 Clopidogrel 組多，這與全球的觀察結果恰恰相反。

This striking regional difference led to AstraZeneca's first FDA application being rejected and raised fundamental questions about the drug's efficacy.

這種顯著的地區差異導致 AstraZeneca 的第一個 FDA 申請被拒絕，並對藥物的療效提出了根本性的質疑。

Second PLATO problem Four countries Israel, us, Georgia and Russia were monitored by independent contract research organizations rather than by Astra.

第二個 PLATO 問題，以色列、美國、喬治亞和俄羅斯這四個國家由獨立的合約研究組織監測，而非由 Astra 監測。

All four independently monitored countries showed numerically higher rates of the primary outcome in the Ticagalar group compared to clopidogrel.

這四個獨立監測的國家，在 Ticagrelar 組與 Clopidogrel 組相比，主要結果的發生率在數字上都更高。

Third problem, there were also discrepancies between death reports submitted to the FDA 938 deaths versus those provided to trial investigators 905 deaths.

第三個問題是，提交給 FDA 的死亡報告（938 例死亡）與提供給試驗調查者的報告（905 例死亡）之間也存在差異。

Now some death causes were reclassified in ways that favored Ticagulor.

現在有些死亡原因被重新分類，對 Ticagulor 有利。

Clopidogrel deaths switched from non vascular to vascular, while some ticagular vascular deaths were switched to non vascular or unknown.

Clopidogrel 的死亡從非血管性改為血管性，而 Ticagrelar 的一些血管性死亡則改為非血管性或未知。

Fourth problem with Plato the unprecedented all cause mortality reduction hazard ratio 0.78 or 107 more lives saved was so large it prompted an editorial titled do you believe in magic?

PLATO 的第四個問題是，前所未見的全因死亡率降低風險比 0.78，或多 saved 107 條生命，如此巨大，引發了一篇標題為「你相信魔法嗎？」的社論。

Because this benefit exceeded what had been seen when comparing active drugs to placebo in similar trials and seems biologically implausible.

因為這個益處超出了在類似試驗中比較活性藥物與安慰劑時所見的結果，而且在生物學上似乎不合理。

Final problem with Thomas Marciniak An FDA reviewer identified a fundamental paradox.

Thomas Marciniak 的最後一個問題，一位 FDA 審查員發現了一個根本性的悖論。

If Ticagulore provided superior platelet inhibition, patients undergoing early PCI should have benefited most, but

如果 Ticagulore 能提供更優越的血小板抑制作用，那麼接受早期 PCI 的患者應該獲益最多，但

they actually fared worse in the short term compared to clopidogrel patients, contradicting the drug's supposed mechanism of action.

他們在短期內實際上比 Clopidogrel 患者情況更糟，這與該藥物聲稱的作用機制相悖。

Now my point is that Ticagulor really didn't look much better than Clopidogrel and was clearly worse than Prosogril in the Isar React 5 trial.

我的重點是，在 Isar React 5 試驗中，Ticagulor 實際上看起來並沒有比 Clopidogrel 好多少，而且明顯比 Prosogril 差。

This was a study with all comers for stents.

這是一項針對所有支架患者的研究。

60% had MI, 21% unstable angina and 20% with chronic coronary syndrome.

60% 發生心肌梗塞，21% 是不穩定型心絞痛，20% 是慢性冠狀動脈症候群。

Okay, the main results at one year the primary endpoint of death, MI, stroke or bleeding occurred in 16.6% taking Ticaglov versus 14.2% taking Prosegril.

好的，一年的主要結果，也就是死亡、心肌梗塞、中風或出血的主要終點，在服用 Ticaglov 的患者中有 16.6%，服用 Prosegril 的患者中有 14.2%。

The risk difference of 2.3 percentage points worse with Ticagulor failed to meet the prespecified threshold for non inferiority.

2.3 個百分點的風險差異，Ticagulor 的情況較差，未能達到預設的非劣效性閾值。

Both the MACE endpoints composite of death MI stroke was higher with ticaglor 10.4 versus 8.6% and also major bleeding was higher 8.4 versus 7.14 with ticagulor compared with Prosogril.

MACE 終點（死亡、心肌梗塞、中風的複合終點）在 ticaglor 組中更高，為 10.4% 對比 8.6%，而 major bleeding（主要出血）在 ticagulor 組中也更高，為 8.4% 對比 7.14%，與 Prosogril 相比。

And the authors concluded that quote in patients with diabetes and multivesal disease undergoing pci, Ticagulore was not non inferior to Prosogril for the reduction of of the primary outcome at one year.

作者們的結論是，引述「在接受 PCI 的糖尿病和多血管疾病患者中，Ticagulore 在一年內減少主要結局方面，並未達到非劣效於 Prosogril。」

I've asked colleagues why they favor Ticagula or Viprosugrel and what I usually get are fairly weak answers.

我問了同事們為什麼他們偏好 Ticagula 或 Viprosugrel，而我通常得到的答案都相當薄弱。

as a cardiologist who does not do stents, I cannot understand why Ticagulore is so dominant over prostagrel in U.S.

作為一名不做支架的心臟科醫師，我無法理解為什麼 Ticagulore 在美國會比 prostagrel 如此普及。

And when Plato was so flawed and isoreact clearly showed Prosogril superiority, what is it that makes Ticagulor so sticky?

而且，當 Plato 試驗如此有缺陷，isoreact 明顯顯示 Prosugrel 的優越性時，是什麼讓 Ticagulor 如此難以取代？

Despite the empirical evidence, I can't know for sure, but there are potential reasons.

儘管有實證，我無法確定，但有幾個可能的原因。

That seems like a weak argument because Dabigatran had the first mover in oral anticoagulants but has been crushed by apixaban and rivaroxaban.

這聽起來是個站不住腳的論點，因為 Dabigatran 在口服抗凝血劑領域是先發者，但卻被 apixaban 和 rivaroxaban 打敗了。

Tachaghilar of course had marketing and messaging.

In fact the twice daily dosing, which is clearly inferior, was positioned as quote, more consistent coverage.

事實上，一天兩次的劑量，這顯然較差，卻被定位為「更一致的覆蓋」。

They had guidelines, initial inertia, right?

他們有指引，有初始的慣性，對吧？

So once Ticagular was embedded in the guidelines as a Class 1 recommendation, it was hard to change.

所以一旦 Ticagular 被納入指引，成為第一類建議，就很難改變了。

There's of course issues with hospital formulary lock in.

醫院藥品表審核機制當然也有問題。

Once hospitals negotiate contracts and build protocols, there can become resistance to change.

一旦醫院談好合約、建立好流程，就會產生改變的阻力。

There's the issue of cognitive biases, right?

So cardiologists who adopted Ticagulor maybe became invested in the decision.

所以那些採用 Ticagulore 的心臟科醫師可能已經認定這個決定了。

There's always a status quo bias, meaning that if something is working and patients do fine, it's continued.

總是有一個維持現狀的偏差，意思是如果某件事奏效，病人也沒事，就會一直沿用下去。

The main quibble I have with Tuxedo though is the choice to do non inferiority design.

不過我對 Tuxedo 試驗的主要抱怨是選擇做非劣性試驗設計。

Non inferiority design means that the new treatment should have some advantage, right?

非劣性試驗設計意味著新療法應該要有某種優勢，對吧？

Less costly, less invasive, less burdensome.

成本較低、侵入性較小、負擔較輕。

I don't really see Ticaglar would justify a non inferiority trial.

我不太明白 Ticaglar 怎麼會合理化一項非劣性試驗。

The PI professor Bangalore wrote to me that the hypothesis started after Isar react 5 where there was a diabetic subgroup and in that subgroup it seemed to be similar outcomes between Ticagalore and Procugrel.

主要研究者 Bangalore 教授寫信給我，說這個假設是在 Isar react 5 試驗之後開始的，當時有一個糖尿病亞組，在這個亞組裡 Ticagalore 和 Procugrel 的結果似乎差不多。

The Mace outcomes were better on Prosegril, bleeding was lower on Prasugil.

Prosegril 的 Mace 結果較佳，Prasugil 的出血量較少。

I wonder what a meta analysis of trials would look like.

我想知道試驗的統合分析會是什麼樣子。

To me, Prasugal looks to be the better drug when doctors feel they need more than clopidogrel.

對我來說，當醫師覺得他們需要比 clopidogrel 更好的藥物時，Prasugal 看起來是比較好的藥物。

Ticagulore Stickiness despite the evidence is a worthy study for students of evidence based medicine.

Ticagulore 儘管有證據，但仍然固執己見，這對實證醫學的學生來說是一項值得研究的課題。

It's just something curious to think about.

這只是個讓人好奇去思考的事情。

Our next topic is the Veritas study of a dual ceiling left atrial appendage closure device.

我們的下一個主題是 Veritas 研究，探討一種雙層封堵左心耳閉合裝置。

Jacky P has published results of the Veritas study of a left atrial appendage closure with a newer generation dual seal occluder made by Abbott.

Jacky P 已經發表了 Veritas 研究的結果，該研究使用 Abbott 生產的新一代雙層封堵器進行左心耳閉合。

But before I tell you about this single arm study of 400 patients, we should mention the irony of calling anything in this space by the Latin word for truth.

但在我告訴你這項針對 400 名患者的單臂研究之前，我們應該提到將這個領域的任何東西命名為拉丁文「真相」的諷刺意味。

I say that because the seminal regulatory trial Prevail missed making non inferiority in its first co primary endpoint of stroke, systemic embolism and CV death Warfarin I'm not going to go into that whole thing again.

我這麼說是因為，開創性的監管試驗 Prevail 在其第一個聯合主要終點中，未能達到非劣效性，該終點包括中風、全身性栓塞和心血管死亡，warfarin 我不會再深入探討了。

Let's not relitigate that left atrial appendage closure, like any procedure is going to iterate.

我們就別再爭論左心耳閉合術，就像任何手術一樣，都會不斷進步。

Procedures iterate and they usually get better.

手術會不斷進步，而且通常會變得更好。

Then the proponents of appendage closure will argue that engineering and technology are going to improve closure rates.

屆時，左心耳閉合術的支持者會主張工程和技術將會改善閉合率。

And if you do that, you should improve outcomes.

如果你這麼做了，結果應該會更好。

Now, I don't doubt the former it's going to improve, but

現在，我並不懷疑前者會進步，但

I highly doubt that we're going to have better outcomes.

Now the Abbott bioengineers have come up with a next generation Amulet device.

現在 Abbott 的生物工程師們已經推出下一代的 Amulet 裝置。

The study was designed to assess 45 day safety and performance outcomes.

這項研究的設計是為了評估 45 天的安全性和表現結果。

It's a single arm study though they screened 650 patients to include 400 patients.

雖然這是一項單臂研究，但他們篩選了 650 名患者，最終納入了 400 名。

And that's sort of important because one in three patients were excluded.

而且這點有點重要，因為有三分之一的病患被排除在外。

The implant success rate was very high, near 100%.

植入成功率非常高，接近百分之百。

Two thirds of the patients were in sinus rhythm, one third were in afib.

三分之二的病患處於竇性心律，三分之一處於心房顫動。

This is strange because if 2/3 were in sinus rhythm, they must have had PAF paroxysmal afib.

這有點奇怪，因為如果三分之二處於竇性心律，他們應該有陣發性心房顫動。

So if they have paroxysmal afib, I'm wondering why weren't they ablated to get rid of the AFib?

所以如果他們有陣發性心房顫動，我很好奇為什麼沒有進行燒灼術來治療心房顫動？

And then if you get rid of the AFib, there's two trials showing that it's reasonable to stop anticoagulation and then you don't have to have a foreign body in your heart.

然後如果治療了心房顫動，有兩項試驗顯示可以合理地停止抗凝血治療，這樣你的心臟裡就不用有異物了。

Now the main findings were that device related thrombus was found in 2.4% of patients.

現在主要的研究結果是，2.4% 的病患發現有裝置相關的血栓。

Major bleeding in 3 any peri device leak small including or 6%.

主要出血事件為 3%，任何裝置周圍滲漏（包含小的）為 6%。

There were two pericardial effusions in 400 patients that required drainage and 24 of 400 patients did not have an adequate TEE for assessment.

有 400 名病患中有兩例心包膜積液需要引流，而 400 名病患中有 24 名沒有足夠的經食道心臟超音波（TEE）進行評估。

The authors and editorialist called these results promising.

作者和社論作者認為這些結果很有希望。

Now, while they were clearly better than previous Amulet data, I'm not sure that they are all that promising.

現在，雖然這些結果明顯優於先前的 Amulet 資料，但我不太確定它們真的那麼有希望。

If you have device related thrombus, it's a failure, an utter failure because it quadruples stroke risk and it requires oral anticoagulation, which is the point of the procedure, to avoid oral anticoagulation.

如果你有裝置相關的血栓，那就是失敗，徹底的失敗，因為它會讓中風風險增加四倍，而且需要口服抗凝血劑，這正是這個手術要避免的。

So 2.4% to me is a lot of device related thrombus given that only super expert implanters participate in this study.

所以對我來說，2.4% 的裝置相關血栓比例很高，因為參與這項研究的都是超級專家級的植入者。

So a 2.4% DRT rate would likely be much worse in less experienced hands.

是以，在經驗較少的人手中，2.4% 的裝置相關血栓（DRT）發生率可能會差很多。

Also, a PERI device leak rate of 6% is less than ideal.

而且，6% 的心包膜裝置滲漏率也不是很理想。

We know that if CT had been used the PERI device, leak would likely be higher.

我們知道如果使用 CT，心包膜裝置滲漏率可能會更高。

字幕列表影片播放

2026年2月13日本週心臟學回顧！ (Feb 13 2026 This Week in Cardiology)

slightly

evidence

diabetes

matter

2026年2月13日 本週心臟學回顧！ (Feb 13 2026 This Week in Cardiology)

slightly

evidence

diabetes

matter

2026年2月13日本週心臟學回顧！ (Feb 13 2026 This Week in Cardiology)