术前负荷量替格瑞洛对急性ST段抬高型心肌梗死急诊介入治疗术中心肌灌注的影响及安全性研究

Effect and Safety of Pre-operative Loading Ticagrelor on Myocardium Reperfusion in Patients With Acute ST-elevation Myocardial Infarction During Primary Percutaneous Coronary Intervention

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术前给予负荷量替格瑞洛对术中心肌灌注的影响及安全性。方法:将12 h内发病并接受急诊PCI的STEMI患者共105例分为替格瑞洛组(58例)和氯吡格雷组(47例)。分别于术前给予替格瑞洛180 mg或氯吡格雷600 mg嚼服。比较两组临床基线情况、PCI术中心肌梗死溶栓治疗临床试验(TIMI)血流分级、校正的TIMI帧数(CTFC)、心肌灌注分级(TMPG)、无复流/慢血流情况。结果:两组临床基线情况差异无统计学意义(P>0.05)。两组患者术前TIMI血流分级差异无统计学意义(P>0.05)。与氯吡格雷组相比,替格瑞洛组术中梗死相关动脉(IRA)开通后TIMI 3级血流、TMPG 3级患者比例明显增加(分别为94.8%vs 80.9%,89.7%vs 72.3%;P均<0.05),CTFC明显改善[(20.0±4.9)帧vs(31.8±3.9)帧,P<0.001],无复流/慢血流发生率较氯吡格雷组低(P=0.016),术后6个月出血事件较氯吡格雷组无明显增加(P>0.05),主要心血管不良事件减少(P<0.05)。结论:在STEMI患者急诊PCI术前给予负荷量的替格瑞洛,可减少术中无复流/慢血流的发生率,改善心肌灌注且较安全,可减少术后主要心血管不良事件发生率。

Objective： To explore the effect and safety ofpre-operative loading ticagrelor on myocardium reperfusion in patients with acute ST-elevation myocardial infarction （STEMI） during primary percutaneous coronary intervention （PCI）. Methods： A total of 105 acute STEMI patients received PCI within 12-hour of onset were studied and they were divided into 2 groups： Ticagrelor group, the patients received pre-operative oral chewing ticagrelor 180 mg, n=58 and Clopidogrel group, the patients received pre-operative oral chewing clopidogrel 600 rag, n=47. The baseline feathers, operative TIMI and corrected TIMI frame count （CTFC）, TIMI myocardial perfusion grade （TMPG）, no-reflow/slow flow conditions were compared between 2 groups. Results： The baseline feathers and pre-operative TIMI were similar between 2 groups, both P〉0.05. Compared with Clopidogrel group, Ticagrelor group showed increased ratios of T1MI 3 flow （94.8% vs 80.9%） and TMPG （89.7% vs 72.3%）, both P〈0.05, improved CTFC （20.0 ± 4.9） vs （31.8 ±3.9）, P〈0.001; decreased rates of no-reflow/slow flow, P=0.016 and less MACE occurrence, P〈0.05; while the post-operative bleeding events were similar between 2 groups, P〉0.05. Conclusion： Prior PC1 loading ticagrelor may reduce no-reflow/slow flow incidence, improve myocardium reperfusion safely and therefore, decrease MACE occurrence in acute STEMI patients.