术前负荷量替格瑞洛对急性ST段抬高型心肌梗死介入治疗的安全性及有效性

Efficacy and safety of preoperative Ticagrelor loading treatment in emergency percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

目的观察术前负荷量替格瑞洛对急性ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入治疗（PCI）的安全性及有效性。方法将213例STEMI患者行急诊介入治疗前随机分为替格瑞洛组（105例）及氯吡格雷组（108例）。替格瑞洛组予替格瑞洛180mg，此后每次90mg，2次／d；氯吡格雷组给予氯吡格雷600mg，此后每次75mg，1次／d；比较两组患者急诊PCI术后冠状动脉TIMI血流情况以及无复流发生率、血小板聚集率变化、出血事件发生率以及主要心血管不良事件（MACE）发生率。结果替格瑞洛组无复流者8例（7．6％），氯吡格雷组无复流者18例（16．7％），差异有统计学意义（χ^2=3．26、P=0．030）；治疗后1h、24h替格瑞洛组血小板聚集率为（55．6±4．3）％、（48．6±4．1）％，氯吡格雷组分别为（63．6±3．8）％、（57．6±3．6）％，聚集抑制效果替格瑞洛组优于氯吡格雷组，差异有统计学意义（t=14．40、17．20，均P=0．001）；两组患者均无主要危及生命的出血事件发生，替格瑞洛组出现次要出血事件为1例（1．0％），氯吡格雷组无次要出血事件发生，两组比较差异无统计学意义（χ^2=0．01、P=0．998）；轻微出血发生率（包括牙龈、皮下出血等）替格瑞洛组和氯吡格雷组分别为6例（5．7％）、4例（3．7％），差异无统计学意义（χ^2=0．14、P=0．710）。替格瑞洛组MACE事件发生率为6．7％（7例），有低于氯吡格雷组8．3％（9例）的趋势，但差异无统计学意义（χ^2=0．04、P=0．840）。结论急性STEMI患者急诊PCI术前使用负荷量替格瑞洛可显著改善患者术后TIMI血流，有更强的抗血小板聚集功能，且不增加出血事件的发生率。

Objective To observe the safety and efficacy of preoperative Ticagrelor loading in emergency percutaneous coronary intervention （PCI）for acute ST segment elevation myocardial infarction（STEMI）. Methods A total of 213 patients with acute STEMI before undergoing emergency PCI were randomly divided into Tieagrelor group （n= 105）receiving 180 mg Ticagrelor loading dose,then 90 mg twice daily and Clopidogrel group（n 108） receiving 600 mg of Clopidogrel, then 75 mg once daily. Emergency PCI postoperative coronary artery TIMI flow grade and the change of incidence of no reflow, platelet aggregation rate, incidence of bleeding events and the incidence of major adverse cardiovascular events（MACE）were compared between two groups. Results The rate of no-reflow was 7.6% （8 cases）in Ticagrelor group, and 16.7%（18 cases）in Clopidogrel group （χ^2=3.26,P=0. 030）. Platelet aggregation rates at 1 h and 24 h after treatment were （55.6±4.3）%o and （48.6±4.1）% respectively inTicagrelor group,and （63.6±3.8）% and（57.6±3.6）% respectively in Clopidogrel group,which showed that platelet aggregation inhibition effect was better in Ticagrelor than in Clopidogrel （t = 14.40,17.20, both P=0. 001 ）. Two groups had no major life-threatening bleeding events. Bleeding incidence had no statistically significant difference between two groups（χ^2= 0.14 ,P=0. 710）,and the incidence of cardiovascular adverse events showed no statistically significant difference（χ^2=0.04,P 0. 840）between the 2 groups. Conclusions Preoperativeticagrelor loading treatment in emergency PCI therapy for acute ST segment elevation myocardial infarction shows stronger antiplatelet aggregation function,significantly improve postoperative TIMI flow,and does not increase the incidence of bleeding events.