替格瑞洛在急诊PCI术中应用的疗效及安全性观察

Curative effect and safety of ticagrelor administrated in emergency percutaneous coronary intervention

目的探讨替格瑞洛在急诊经皮冠状动脉介入治疗(PCI)术中应用的疗效及安全性。方法2013年1月至2014年3月在我院诊断为急性心肌梗死并急诊行PCI术的患者共192例,随机分为替格瑞洛组(n=105)和氯吡格雷组(n=87),对两组患者的临床资料进行统计学分析,对比住院期间及随访3月不稳定性心绞痛、心肌梗死、死亡等主要不良心脑血管事件(MACCE)发生率及出血、呼吸困难等不良事件发生率。结果两组的基本情况无统计学差异(P>0.05);术后随访3个月发现MACCE事件发生率替格瑞洛组明显低于氯吡格雷组(P<0.05),出血发生率两组无统计学差异(P>0.05);氯吡格雷组中有6例再发急性冠脉综合征(ACS),均再次行PCI干预,改用替格瑞洛术前负荷剂量180 mg,术后90 mg2/日,分别于术前及后24 h查血栓弹力图,结果显示ADP抑制率及ADP诱导的血小板-纤维蛋白凝块强度(MAADP)应用替格瑞洛后均优于应用替格瑞洛前(P<0.05)。结论替格瑞洛较氯吡格雷在我国人群急诊PCI术中具有更好的疗效及安全性。

Objective To discuss the curative effect and safety of ticagrelor administrated in emergency percutaneous coronary intervention （PCI）. Methods The patients （n=192） with acute myocardial infarction （AMI） undergone emergency PCI were chosen from Jan. 2013 to Mar. 2014, and randomly divided into ticagrelor group （n=105） and clopidogrel group （n=87）. The clinical data of patients were analyzed statistically. The incidence of major adverse cardiovascular and cerebrovascular events （MACCE, including unstable angina pectoris, myocardial infarction and death）, bleeding and dyspnea were compared between 2 groups during hospital stay and after follow-up for 3 m. Results The general conditions had no statistical difference between 2 groups （P〉0.05）. After follow-up for 3 m, the incidence of MACCE was significantly lower in ticagrelor group than that in clopidogrel group （P〈0.05）, and incidence of bleeding had no statistical difference between 2 groups （P〉0.05）. There were 6 cases with recurrent acute coronary syndrome （ACS） in clopidogrel group, and then they were given secondary PCI and ticagrelor replacing clopidogrel （preoperative dose of 180 mg and 90 mg three times a day after PCI）. These patients were given thrombelastogram examination before and 24 h after PCI, and the outcomes showed that ADP inhibitory rate and ADP-induced platelet-fibrin clot strength （MAADP） were all higher after ticagrelor administration （P〈0.05）. Conclusion Ticagrelor has higher curative effect and safety than clopidogrel in population undergone emergency PCI.