急性心肌梗死患者介入治疗后应用替格瑞洛抗血小板聚集的效果及预后分析

Anti-platelet aggregation effect of ticagrelor in patients with acute myocardial infarction after interventional treatment and prognosis analysis

目的研究急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后应用替格瑞洛的抗血小板聚集效果及其预后。方法选取2017年3月至2019年8月于航空总医院心血管科住院的AMI并行PCI治疗的住院患者280例,随机分为观察组和对照组两组,每组各140例。观察组患者给予替格瑞洛(90 mg bid)治疗,对照组给予氯吡格雷(75 mg qd)治疗。比较两组患者术后7 d,30 d及1年的血小板最大聚集率(MAR)、血小板聚集抑制率(IPA)、不良事件发生情况以及1年后主要不良心脑血管事件(MACCE)与出血事件发生情况。结果服药前两组患者的MAR比较,差异无统计学意义(P>0.05);两组患者服药后7 d、30 d后的MAR水平都低于服药前,差异显著(P<0.05);而两组服药后7 d、30 d及1年的MAR水平比较,差异无统计学意义(P>0.05);两组之间比较,对照组患者服药7 d、30 d及1年后MAR水平均显著高于观察组,差异具有统计学意义(P<0.05);服药7 d、30 d及1年时,对照组患者的IPA水平高于观察组,两组比较差异显著(P<0.05);随访至1年,观察组患者的MACCE显著低于对照组(2.4%vs.7.2%,P=0.012),其中靶血管再次血运重建(TVR)比例显著低于对照组(5.3%vs.11.8%,P=0.007)。随访至1年,观察组患者小出血风险显著低于对照组(4.5%vs.11.1%,P=0.015),大出血方面则无显著差异(1.0%vs.1.8%,P=0.687)。结论采用替格瑞洛能够有效的抑制血小板聚集,且可显著降低TVR和MACCE事件,对患者预后具有积极作用。

Objective To study the anti-platelet aggregation effect of ticagrelor and prognosis in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI).Methods AMI patients undergone PCI(n=280)were chosen from Department of Cardiovascular Medicine in Aviation General Hospital from Mar.2017 to Aug.2019,and then divided randomly into observation group and control group(each n=140).The observation was treated with ticagrelor(90 mg bid)and control group was treated with clopidogrel(75 mg qd).The maximum platelet aggregation rate(MAR),inhibitory rate of platelet aggregation(IPA)and incidence of adverse events were compared after PCI for 7 d,30 d and 1 y,and incidence of major adverse cardiovascular and cerebrovascular events(MACCE)and bleeding events were compared after 1 y between 2 groups.Results The comparison in MAR level had no statistical significance between 2 groups before medication(P>0.05).MAR level was lower in 2 groups after medication for 7 d and 30 d compared with before(P<0.05),and comparison in MAR level had no statistical significance in 2 groups after medication for 7 d,30 d and 1 y(P>0.05).The comparison between 2 groups showed that MAR level was significantly higher in control group than that in observation group after medication for 7 d,30 d and 1 y(P<0.05).IPA level was higher in control group than that in observation group after medication for 7 d,30 d and 1 y(P<0.05).After followed up for 1 y,the incidence rate of MACCE was significant lower(2.4%vs.7.2%,P=0.012)and target vessel revascularization(TVR)was significant lower(5.3%vs.11.8%,P=0.007)in observation group that those in control group.After followed up for 1 y,the risk of mild bleeding was significantly lower in observation group than that in control group(4.5%vs.11.1%,P=0.015),and risk of severe bleeding had no significant difference between 2 groups(1.0%vs.1.8%,P=0.687).Conclusion Ticagrelor can effectively inhibit platelet aggregation and significantly reduce TVR level and MACCE incidence,and it has positive effect on prognosis in AMI patients.