Abstract: Background　Aspirin is the cornerstone for treating acute myocardial infarction，but about 2%-9% of patients can develop aspirin intolerance. Cilostazol may be used as an alternative to aspirin，but its cardiovascular safety is unclear. Objective　To investigate the safety of cilostazol in acute myocardial infarction patients with congestive heart failure and aspirin intolerance. Methods　Patients with a primary diagnosis of acute myocardial infarction and congestive heart failure who were hospitalized in three hospitals（Affiliated Hospital of North Sichan Medical College，Pengan County People's Hospital，Changan Branch，the First Affiliated Hospital of Xi'an Jiaotong University） from January 2018 to August 2019 were retrospectively included. All were treated according to the diagnosis and treatment criteria of myocardial infarction. Specifically，those with aspirin intolerance received cilostazol and clopidogrel （cases），and the other received aspirin and clopidogrel（controls），and the two groups were matched based on propensity scores in a 1∶1 ratio. Outcomes were compared between the groups in terms of 1-year cardiac death，1-year readmission for heart failure，left ventricular diastolic diameter，and ejection fraction measured by echocardiography before and after treatment. Multivariate Logistic regression analysis was used to explore factors associated with 1-year cardiac death and heart failure readmission. Results　Of the 5 244 hospitalized cases in the period，3 893 who met the inclusion and exclusion criteria were finally included. After matching，the cases and controls had no statistically notable differences in left ventricular diastolic diameter，and ejection fraction（P>0.05）. But the cases had higher rates of 1-year cardiac death and heart failure readmission（P<0.05）. Multivariate Logistic regression analysis showed that NYHA class ⅢandⅣ，and combined with diabetes were associated with 1-year cardiac death （P<0.05）. NYHA class ⅢandⅣ，diabetes，and cilostazol treatment for more than 90 days were recognized as the influencing factors of heart failure readmission （P<0.05）. Conclusion　It may be safe to use cilostazol in acute myocardial infarction patients with NYHA class Ⅰ and Ⅱ. Given increased safety risks，cilostazol is not recommended for those with NYHA classⅢandⅣ，and combined with diabetes. Moreover，cilostazol is not suggested to be used for more than 90 days，due to increased potential risks of heart failure readmission. 

Key words: Myocardial infarction, Heart failure, Cilostazol, Aspirin, Drug tolerance, Cohort studies

摘要： 背景　阿司匹林是急性心肌梗死的治疗基石，2%~9%的患者可发生阿司匹林不耐受，西洛他唑可作为阿司匹林的替代药物，然而其心血管安全性尚不明确。目的　探讨急性心肌梗死伴充血性心力衰竭患者发生阿司匹林不耐受时使用西洛他唑的安全性。方法　回顾性选取2018年1月至2019年8月在川北医学院附属医院、蓬安县人民医院、西安交通大学第一附属医院长安区医院住院，主要诊断为急性心肌梗死合并充血性心力衰竭患者。患者均按心肌梗死诊疗规范治疗，对于阿司匹林不耐受者，使用西洛他唑+氯吡格雷作为暴露组，使用阿司匹林+氯吡格雷作为非暴露组，用倾向评分匹配的方法按1∶1匹配两组。比较两组1年内心源性死亡率、1年内心力衰竭再入院率、心脏彩超指标左心室大小（LV）改变值及射血分数（EF）改变值。对于1年内心源性死亡、心力衰竭再入院的影响因素分析采用多因素Logistic回归分析。结果　主要诊断为急性心肌梗死患者5 244例，其中符合纳入、排除标准的患者3 893例。匹配后暴露组和非暴露组LV改变值、EF改变值比较，差异均无统计学意义（P>0.05）；匹配后暴露组心源性死亡率、心力衰竭再入院率高于非暴露组（P<0.05）。多因素Logistic回归分析结果显示，NYHA心功能Ⅲ级、Ⅳ级，合并糖尿病为1年内心源性死亡的影响因素（P<0.05）；NYHA心功能Ⅲ级、Ⅳ级，合并糖尿病，西洛他唑疗程>90 d为1年内心力衰竭再入院的影响因素（P<0.05）。结论　对心功能Ⅰ级、Ⅱ级的心肌梗死患者应用西洛他唑可能是安全的，但对心功能Ⅲ级、Ⅳ级，合并糖尿病的患者应用西洛他唑的安全风险增加，西洛他唑疗程也不宜>90 d，因可能增加心力衰竭再入院率。

关键词: 心肌梗死, 心力衰竭, 西洛他唑, 阿司匹林, 药物耐受性, 队列研究