替格瑞洛与氯吡格雷对急性心肌梗死患者行急诊PCI的临床效果和安全性对比

Comparison of clinical efficacy and safety of emergency treatment with ticagrelor and clopidogrel in patients with acute myocardial infarction undergoing emergency PCI

目的探讨替格瑞洛与氯吡格雷在急性心肌梗死(AMI)患者急诊行经皮冠状动脉介入治疗(PCI)时的临床疗效和安全性。方法选择2015年6月至2017年2月该科收治的急诊行PCI的AMI患者182例,分为观察组91例和对照组91例。观察组术前及术后1周使用阿司匹林联合替格瑞洛进行治疗,术后1周后改为阿司匹林联合氯吡格雷;对照组术前及术后均给予阿司匹林联合氯吡格雷治疗。比较两组患者术前、术后的TIMI血流分级、TMPG心肌灌注分级,以及术前、术后1周内患者的左室射血分数(LVEF)、左室舒张末径(LVEDD)、血小板聚集率,记录6个月随访中所有患者主要心血管不良事件(MACE)及出血事件发生情况。结果经过PCI,两组患者的TIMI及TMPG分级均显著改善,同时术后观察组TIMI分级明显优于对照组,差异有统计学意义(P<0.05);术后两组患者的LVEF均明显升高,而LVEDD及血小板聚集率均显著降低,且术后观察组患者的LVEF、LVEDD、血小板聚集率均明显优于对照组患者,差异有统计学意义(P<0.05);观察组术后6个月内MACE发生率显著低于对照组患者,差异有统计学意义(P<0.05),而两组患者的出血事件发生率比较,差异无统计学意义(P>0.05)。结论对于急诊行PCI治疗的AMI患者,替格瑞洛比氯吡格雷疗效更佳,能够迅速恢复患者心肌灌注,对血小板聚集抑制作用更明显,有效降低MACE,提高预后,不增加出血风险,临床效果及安全性良好,值得临床推广。

Objective To investigate the clinical efficacy and safety of ticagrelor and clopidogrel in emergency patients with acute myocardial infarction after percutaneous coronary intervention.Methods During the period of June 2015 to February 2017,182 cases of AMI with PCI admitted to the emergency department of our hospital,according to the random number table method,all patients were divided into observation group 91 cases and control group 91 cases,the patients in the observation group were treated with aspirin and Grillo for one week before and after the operation,and Clopidogrel would be replaced with clopidogrel one week after surgery,the patients in the control group were treated with aspirin and clopidogrel before and after the operation.The TIMI blood flow classification,TMPG myocardial perfusion classification,and left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and platelet aggregation rate were compared between the two groups before and after operation,and the myocardial perfusion classification was performed preoperatively and postoperatively,The major adverse cardiovascular events(MACE)and bleeding events were recorded in all patients at 6 months of follow-up.Results After PCI,TIMI and TMPG grade of the two groups were significantly improved,and postoperative TIMI grade were significantly better than the control group,the difference was statistically significant(P<0.05);after two groups of patients with LVEF were significantly increased,while LVEDD and platelet aggregation rate were significantly decreased,and the postoperative observation with LVEF,LVEDD,platelet aggregation rate were significantly better than the control group,the differences were statistically significant(P<0.05);the incidence of major cardiovascular events was significantly lower than the control group of patients within 6 months of the patients in the observation group,the difference was statistically significant(P<0.05),and the two groups of patients with bleeding events the total incidence rate comparison,the difference was not statistically significant(P>0.05).Conclusion Ticagrelor for emergency PCI treatment of AMI patients with better curative effect than clopidogrel,it can significantly improve myocardial perfusion,inhibit platelet aggregation more obviously,significantly reduce MACE,improve prognosis,without increasing the risk of bleeding.The clinical effect and safety are good.It is worthy of clinical promotion.