新型抗栓药替格瑞洛对急诊经皮冠状动脉介入治疗的近期疗效及安全性评价

Evaluation of recent antithrombotic efficacy and safety for Ticagrelor after emergency percutaneous coronary intervention

目的评价新型抗栓药替格瑞洛对急诊经皮冠状动脉介入治疗（PCI）抗栓的有效性及安全性。方法选择2013年9-12月收治的80例发病12h以内、接受急诊PCI的急性ST段抬高型心肌梗死（STEMI）患者为研究对象，采用随机数字表随机分为替格瑞洛组（40例）和氯吡格雷组（40例）。术前及术后分别使用替格瑞洛和氯吡格雷抗栓，观察并比较两组患者的基线资料、冠状动脉病变特征、心肌梗死溶栓试验（TIMI）血流分级、术后5d血小板聚集率以及30d主要不良心血管事件（MACE）等，评价安全性的指标主要为出血并发症和呼吸困难等不良反应。结果两组患者基线资料、病变支数、TIMI血流分级差异均无统计学意义（P〉0．05）。两组患者随访30d，均无再发心肌梗死、支架内血栓、心源性死亡发生。两组患者急诊PCI术前凝血指标及术后5d血小板计数差异均无统计学意义（P〉0．05）。替格瑞洛组术后5d血小板聚集率明显优于氯吡格雷组（P〈0．01）。两组均无严重出血发生，无血小板减少。替格瑞洛组有4例呼吸困难不良反应，经换用氯吡格雷后症状缓解；氯吡格雷组无呼吸困难发生，两组差异有统计学意义（P〈0．05）。结论新型抗栓药替格瑞洛对急诊PCI术的抗栓治疗具有良好的安全性和有效性。

Objective To evaluate the efficacy and safety of Ticagrelor-a new antithrombotic drug in pa- tients with acute ST-elevation myocardial infarction （STEMI） with underwent emergency percutaneous coronary in- tervention （PCI）. Methods Eighty STEMI patients admitted from September 2013 to December 2013 had symp- toms （〈12 h） and received emergency PCI, and they were randomly divided into Ticagrelor group （n=40） and Clopidogrel group （n=40）. The baseline data, angiographic characteristics, TIMI blood flow, platelet aggregation rate in 5 days after emergency PCI and major adverse cardiovascular events（MACE） at 30 days were observed and compare between two groups. The major safety evaluation was based on mild or severe bleeding and dyspnea. Results No significant difference was noted in baseline data, number of diseased vessels and TIMI blood flow be- tween two groups（P〉0.05 ）. No deaths, stent thrombosis or recurrent myocardial infarction occurred during 30-day follow-up. There was no significant difference of coagulation index at pre-PCI and platelet count at 5 days after PCI between two groups （P〉0.05）. Antithrombotic effect at 5 days after PCI was stronger in Ticagrelor group than in Clopidogrel group （P〈0.01）. Bleeding events were similar in both groups （P〉0.05）. There were four patients with dyspnea in Tieagrelor group and no one had dyspnea in Clopidogrel group（P〈0.05 ）. Conclusion Ticagrelor, as a new antithrombotic drug used after emergency PCI shows good efficacy and safety in STEMI.