替格瑞洛与氯吡格雷序贯治疗对STEMI急诊PCI患者血小板聚集率及MACE的影响

Influence of sequential therapy of ticagrelor and clopidogrel on platelet aggregation rate and major adverse cardiovascular events in patients with STEMI undergone emergency PCI

目的 探讨行急诊经皮冠状动脉介入治疗（PCI）急性ST段抬高型心肌梗死（STEMI）患者替格瑞洛与氯吡格雷序贯治疗对血小板聚集率及主要不良心血管事件（MACE）的影响。方法 选择2012年2月~2015年3月黑龙江佳木斯市中心医院心内科收治急性STEMI并行急诊PCI治疗的患者92例,随机分为替格瑞洛组（n=30）、氯吡格雷组（n=30）与序贯治疗组（n=32）3组。替格瑞洛组给予替格瑞洛口服;氯吡格雷组给予氯吡格雷口服;序贯治疗组先给予替格瑞洛口服,7 d后更改为氯吡格雷口服。检测急诊PCI术前及术后2 h、24 h、7 d及30 d时血小板聚集率,并观察患者30 d内MACE及出血事件的发生率。结果 3组患者急诊PCI术后血小板聚集率较术前均明显下降（P〈0.05）;在术后2 h、24 h、7 d时间点替格瑞洛组血小板聚集率与氯吡格雷组比较下降更明显（P〈0.05）;在术后2 h、24 h、7 d、30 d时间点序贯治疗组与替格瑞洛组血小板聚集率差异无统计学意义（P〉0.05）;替格瑞洛组与序贯治疗组30d内MACE事件发生率均低于氯吡格雷组（P〈0.05）;住院期间3组出血事件发生率差异无显著性（P〉0.05）。结论 STEMI患者行急诊PCI术前应用替格瑞洛抗血小板治疗,可显著抑制血小板聚集,降低30 d内MACE事件且不增加出血风险;STEMI患者PCI术一周后口服氯吡格雷替代替格瑞洛具有与替格瑞洛同样的疗效。

Objective To investigate the influence of sequential therapy of ticagrelor and clopidogrel on platelet aggregation rate （PAG） and major adverse cardiovascular events （MACE） in patients with ST-segment elevation myocardial infarction （STEMI） undergone emergency PCI. Methods The patients with STEMI （n=92） were chosen from Feb. 2012 to Mar. 2015, and then randomly divided into ticagrelor group （given orally ticagrelor, n=30）, elopidogrel group （given orally clopidogrel, n=30） and sequential therapy group （given orally ticagrelor at first and clopidogrel after 7 d, n=32）. The changes of PAG were detected before PC1 and after PCI for 2 h, 24 h, 7 d and 30 d, and incidence of MACE and bleeding events were observed within 30 d. Resutls After PCI, PAG decreased significantly in 3 groups （P〈0.05）. At the time points of 2 h, 24 h and 7 d after PCI, PAG decreased more significantly in ticagrelor group compared with clopidogrel group （P〈0.05）. At the time points of 2 h, 24 h, 7 d and 30 d, the difference in PAG had no statistical significance between sequential therapy group and ticagrelor group （P〉0.05）. The incidence of MACE within 30 d was lower in ticagrelor group and sequential therapy group than that in clopidogrel group （P〈0.05）. The incidence of bleeding events had no significant difference among 3 groups during hospitalization （P〉0.05）. Conclusion Before emergency PCI, anti-platelet therapy with ticagrelor applied in STEMI patients can significantly inhibit platelet aggregation, reduce MACE within 30 d, and cannot increase bleeding risk. Clopidogrel is orally given to STEMI patients for replacing ticagrelor 7 d after PCI has the same curative effect.