急性冠状动脉综合征行PCI术后氯吡格雷和替格瑞洛引起心律失常的比较

Comparison of the Effects of Clopidogrel and Tigrine on Arrhythmia Induced by PCI in Patients with Acute Coronary Syndromes

目的分析急性冠状动脉综合征(ACS)患者行冠状动脉介入(PCI)术后氯吡格雷和替格瑞洛引起心律失常的作用差异。方法选择PCI择术期224例ACS患者为研究对象,按入院顺序随机分为替格瑞洛组和氯吡格雷组,每组112例。所有患者在PCI术后给予100mg/d阿司匹林基础治疗,在此基础上,替格瑞洛组给予负荷剂量180mg,维持剂量为90毫克/次,2次/天,氯吡格雷组给予负荷剂量300mg,维持剂量为75毫克/次,1次/天。随访1年,分别在PCI术后1、6和12个月时,对两组患者进行24h动态心电图监测,记录两组患者的心律失常相关的不良事件。结果术后1个月和6个月,两组患者的心率(HR)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)无明显变化(P>0.05);12个月后,替格瑞洛组的HR和LVEF明显下降,LVESD和LVEDD明显增高,与氯吡格雷组比较,差异有统计学意义(P<0.05,P<0.01)。两组患者在术后1、6和12个月时,无明显症状的快速性心律失常发生率、缓慢性心律失常发生率和总心律失常发生率差异均无统计学意义(P>0.05)。两组患者发生房性期前收缩和室性期前收缩的次数亦均无显著变化(P>0.05)。另外,术后12个月,替格瑞洛组停搏11例(9.82%),明显高于氯吡格雷组的7例(6.25%),差异有统计学意义(P<0.01);在两组患者中,≥4s的停搏率、多次停搏率和白天停搏率均高于2~4s停搏率、1次停搏率和夜间停搏率,在术后12个月时,以上差异均有统计学意义(P<0.01)。结论 PCI术后抗血小板治疗中,使用替格瑞洛导致的无症状心律失常不良事件主要以心脏停搏为主,其发生率明显高于氯吡格雷,必要时可给予抗心律失常药物。

Objective To investigate the effect of clopidogrel and tigrine on arrhythmia induced by percutaneous coronary intervention （PCI） in patients with acute coronary syndromes （ACS）. Methods A total of 224 patients with PCI were selected as the study subjects. The patients were randomly divided into Tegrella group （ n =112） and clopidogrel group （ n =112）. On the basis of 100mg/d aspirin after PCI, Ticagrelor group was given loading dose of 180mg and maintenance dose of 90mg/d, 2 times for one day. And Clopidogrel group was given loading dose of 300mg and maintenance dose of 75mg/d, once one day. All patients were followed up for 1 year. The two groups were monitored by twelve lead Holter in 24 hours in 1, 6 and 12 months after PCI. The arrhythmia-related adverse events were recorded in both groups. Results There were no significant changes in heart rate （HR）, left ventricular ejection fraction （LVEF）, left ventricular end systolic diameter （LVESD） and left ventricular end diastolic diameter （LVEDD） in both groups （ P 〉0.05）. After 12 months, HR and LVEF were significantly decreased, LVESD and LVEDD were significantly increased in the Tegrella group, compared with clopidogrel group, the difference was statistically significant （ P 〈0.05, P 〈0.01）. There was no significant differences in the incidence of asymptomatic tachyarrhythmias, chronic arrhythmia and the total arrhythmia between the two groups at 1, 6 and 12 months after operation （ P 〉0.05）. At the same time, there was also no significant changes in atrial premature beats and ventricular premature beats in both groups （ P 〉0.05）. In addition, after 12 months of PCI, 11 cases （9.82%） stopped in the tegrine group was significantly higher than that in the clopidogrel group （7.25%） （ P 〈0.01）. In the two groups, the incidence of ≥ 4 arrest, multiple arrest and daytime arrest were higher than the incidence of 2-4s arrest, arrest once and nocturnal arrest. In 12 months after PCI, the above differences were statistically significant （ P 〈0.01）. Conclusion In patients with anti-platelet therapy after PCI, the incidence of asymptomatic arrhythmia adverse events caused by tigrolil is mainly due to arrest, the incidence is significantly higher than clopidogrel, and antiarrhythmic drugs may be given if necessary.