替格瑞洛对接受经皮冠状动脉介入治疗左主干病变冠心病患者影响研究

Effects of Ticagrelor on patients with coronary heart disease who received percutaneous coronary intervention for left main coronary artery disease

目的探讨替格瑞洛对接受经皮冠状动脉介入治疗(PCI)的左主干病变冠心病患者的影响。方法选取北部战区总医院自2018年1月至2019年9月收治的125例接受PCI的左主干病变冠心病患者为研究对象,其中,氯吡格雷组75例,替格瑞洛组50例。两组均给予阿司匹林肠溶片,入院时嚼服300 mg,次日起100 mg/次,每天1次。氯吡格雷组给予硫酸氢氯吡格雷片,入院时嚼服300 mg,次日起75 mg/次,每天1次;PCI后次日改为150 mg/次,每天1次;PCI 2周后改为75 mg/次,每天1次。替格瑞洛组给予替格瑞洛片,入院时嚼服180 mg,次日起90 mg/次,每天2次。治疗1年,氯吡格雷组失访4例,替格瑞洛组失访3例。整理患者的一般资料、化验和心脏超声指标等,记录PCI相关情况、CRUSADE评分、GRACE评分、SYNTAX评分、危险分层、BARC出血分型等,计算主要心脏不良事件[非致死性急性心肌梗死、缺血性卒中、支架内再狭窄或血栓形成、靶血管血运(再次)重建、心源性死亡]、次要心脏不良事件(严重心律失常、心力衰竭)及出血事件发生率。结果替格瑞洛组患者的平均年龄、平均ADP、分叉病变比例、CRUSADE评分均低于氯吡格雷组,差异有统计学意义(P<0.05)。两组主要心脏不良事件发生率比较,差异无统计学意义(P>0.05);在次要心脏不良事件中,替格瑞洛组的严重心律失常发生率低于氯吡格雷组,差异有统计学意义(P<0.05)。两组BARC出血分型和出血事件发生率比较,差异均无统计学意义(P>0.05)。结论对于接受PCI的左主干病变冠心病患者而言,替格瑞洛的临床疗效优于氯吡格雷,且可降低次要心脏不良事件发生率。

Objective To investigate the effect of Ticagrelor on patients with left main coronary artery disease who underwent percutaneous coronary intervention(PCI).Methods A retrospective study was performed on 125 cases of patients with coronary heart disease(CHD)of left main artery disease receiving PCI admitted from January 2018 to September 2019.Patients were randomly divided into the Ticagrelor group(n=75)and the clopidogrel group(n=50).Both groups of patients were given aspirin enteric-coated tablets,chewed for 300 mg on admission,and 100 mg/time from the next day,once a day.Clopidogrel group of patients were given clopidogrel hydrochloride tablets,300 mg chewable at admission,75 mg/time from the next day,once a day.The next day after PCI was changed to 150 mg/time,once per day;PCI was changed to 75 mg/time once a day after 2 weeks.Ticagrelor group of patients were given Ticagrelor tablets,which were chewed for 180 mg on admission and 90 mg/time from the next day,twice a day.After 1 year of treatment,4 cases were lost to follow-up in clopidogrel group and 3 cases were lost to follow-up in Ticagrelor group.The patient′s general information,laboratory test and echocardiographic indexes,such as PCI related situation,the CRUSADE score,GRACE score,SYNTAX score,risk stratification,part of bleeding points,calculation of major adverse cardiac events[nonfatal acute myocardial infarction,ischemic stroke,stent restenosis or target vascular thrombosis,blood supply reconstruction(again),cardiac death],secondary adverse cardiac events(severe arrhythmia,heart failure)and the incidence of bleeding events were analyzed.Results The average age,the average ADP,the ratio of bifurcation lesion and the CRUSADE score of the patients in the Ticagrelor group were all lower than that in the clopidogrel group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of major cardiac adverse events between the two groups(P>0.05).Among secondary adverse cardiac events,the incidence of severe arrhythmia in Ticagrelor group was lower than that in clopidogrel group(P<0.05).There was no significant difference in the type and incidence of BARC bleeding between the two groups(P>0.05).Conclusion For patients with coronary heart disease with left main disease who received PCI,Ticagrelor showed superior clinical efficacy over clopidogrel and reduced the incidence of secondary adverse cardiac events.