氯吡格雷在急性前壁心肌梗死行急诊经皮冠状动脉介入治疗患者的应用

Application of clopidogrel in patients with acute anterior myocardial infarction undergoing emergency percutaneous coronary intervention

目的探讨氯吡格雷在急性前壁心肌梗死(MI)患者经皮冠状动脉介入治疗(PCI)的应用效果。方法急性前壁MI行急诊PCI患者160例,随机均分为四组:A组和B组术前氯吡格雷负荷量均为300mg,术后每日维持量分别为75mg和150mg;C组和D组术前负荷量氯吡格雷600mg,术后每日维持量分别为75mg和150mg。随访1个月,观察各组间出血及主要心脏不良事件(MACE)发生情况。结果术前负荷量氯吡格雷300mg组发生MACE的风险大于600mg组[OR=2.46,95%CI(1.04-5.84),P=0.04],而术后维持用氯吡格雷75mg与150mg发生MACE的风险相仿[OR=0.84,95%CI(0.37-1.92),P=0.67]。结论对于急性前壁MI患者,PCI术前应用负荷量氯吡格雷600mg较300mg更能有效减少术后1个月内的MACE发生率。

Objective To investigate the efficacy of clopidogrel in the patients with acute anterior myocardial infarction（MI） undergoing percutaneous coronary intervention（PCI）. Methods A total of 160 patients with acute anterior MI and undergoing PCI was randomly assigned into four groups. The patients in groups of A and B were given clopidogrel 300 mg before PCI, which was followed by a maintenance dose of 75 mg/d and 150 mg/d, respectively. The patients in groups of C and D were given clopidogrel 600 mg before PCI, which was followed by a maintenance dose of 75 mg/d and 150 rag/d, respectively. All patients were followed up for 30 days and the incidence of bleeding and major adverse cardiovascular events（MACE） were recorded. Results The risk of MACE was higher in groups of A and B than that in groups of C and D [OR = 2. 46,95% CI （1.04-5.84）, P=0. 04],which was not significantly different between groups of A and C and groups of B and D FOR= 0.84, 95% CI （0. 37-1.92）, P=0. 67）]. Conclusion A loading dose of clopidogrel 600 mg before PCI is more effective in reducing the incidence of MACE in the patients with acute anterior MI undergoing PCI.