替格瑞洛对行急诊冠脉介入治疗的急性ST段抬高型心肌梗死患者心肌灌注的影响

Influence of ticagrelor on myocardial perfusion in patients with acute ST-segment elevation myocardial infarction(STEMI) undergone emergency PCI

目的评价替格瑞洛对行经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者术后心肌灌注的影响。方法连续入选2015年12月～2016年12月以STEMI就诊于河北省人民医院并行急诊PCI治疗的患者123例,术前应用随机数字量表分为替格瑞洛组61例和氯吡格雷组62例。明确诊断后即刻口服负荷量抗血小板药物,替格瑞洛组患者口服阿司匹林+替格瑞洛,继以替格瑞洛维持。氯吡格雷组患者术前口服阿司匹林+氯吡格雷,继以氯吡格雷维持。比较术中心肌梗死溶栓试验血流(TIMI)分级,校正TIMI血流帧数计数(CTFC),TIMI心肌灌注分级(TMPG),并观察住院期间患者用药不良反应及安全性。结果两组患者一般基线资料比较均无统计学意义(P>0.05);PCI术后替格瑞洛组患者总体CTFC数值、具体血管(LAD、LCX、RCA)比较均小于氯吡格雷组;替格瑞洛组中TIMI>3级所占比例、术后心肌灌注TMPG 3级比例高于氯吡格雷组,所有差异均有统计学差异(P<0.05)。两组的主要心脏不良事件及出血情况比较,差异无统计学意义(P>0.05)。结论对于行急诊PCI术的ST段抬高型心肌梗死患者,替格瑞洛可改善其术后心肌层面的血流灌注,且用药安全。

Objective To review the influence of ticagrelor on postoperative myocardial perfusion in patients with acute ST-segment elevation myocardial infarction(STEMI)undergone emergency percutaneous coronary intervention(PCI).Methods The patients(n=123)with STEMI undergone emergency PCI were continuously chosen from People’s Hospital of Hebei Province from Dec.2015 to Dec.2016.All patients were randomly divided into ticagrelor group(n=61)and clopidogrel group(n=62)before PCI.After clarifying the diagnosis,the patients were immediately given antiplatelet drugs orally in loading dose.The ticagrelor group was orally given aspirin and ticagrelor before PCI followed by ticagrelor for maintain,and clopidogrel group was orally given aspirin and clopidogrel before PCI followed by clopidogrel maintain.The grades of thrombolytic test for myocardial infarction(TIMI),corrected TIMI frame count(CTFC)and TIMI myocardial perfusion grade(TMPG)were compared during PCI,and adverse reactions and safety of drugs were observed during hospitalization.Results The comparison in general baseline data had no statistical significance between 2 groups(P>0.05).The total CTFC and specific blood vessels(LAD,LCX and RCA)were lower in ticagrelor group than those in clopidogrel group after PCI.The percentages of TIMI>3,and TMPG 3 of myocardial perfusion were higher in ticagrelor group than those in clopidogrel group after PCI(P<0.05).The comparison in incidence of major adverse cardiovascular events(MACE)and bleeding events showed that the difference had no statistical significance between 2 groups(P>0.05).Conclusion Ticagrelor,with higher safety,can improve myocardial perfusion after PCI in patients with STEMI undergone emergency PCI.