老年AMI患者在急诊PCI使用替格瑞洛的近期疗效及安全性

Short-term therapeutic effect of ticagrelor on aged AMI patients during emergency PCI and its safety

目的:探讨老年急性心肌梗死(AMI)患者在急诊经皮冠状动脉介入治疗(PCI)中使用替格瑞洛的近期疗效及安全性。方法:选择在我院诊断为急性ST段抬高心肌梗死并急诊行PCI的老年患者共170例,随机分为替格瑞洛组(85例)和氯吡格雷组(85例),观察并比较两组术后7d血小板计数、血小板抑制率等的变化以及住院期间和随访6月主要不良心脑血管事件(MACCE)、出血等不良事件发生率。结果:术后7d,与氯吡格雷组比较,替格瑞洛组二磷酸腺苷(ADP)抑制率[(66.9±11.7)%比(86.5±9.4)%]显著升高,ADP诱导的血小板-纤维蛋白凝块强度(MAADP)[(52.0±4.1)mm比(39.3±4.6)mm]显著减小,P均=0.001;两组院内及术后随访6个月MACCE事件发生率无显著差异,P=0.115;但替格瑞洛组出血发生率显著高于氯吡格雷组(21.2%比9.4%,P=0.033)。结论:替格瑞洛较氯吡格雷在老年急诊PCI患者疗效更好,但出血风险增加。

Objective:To explore short-term therapeutic effect of ticagrelor on aged patients with acute myocardial infarction(AMI)during emergency percutaneous coronary intervention(PCI)and its safety.Methods:A total of 170 aged patients,who were diagnosed as acute ST segment elevation myocardial infarction and received emergency PCI in our hospital,were randomly divided into ticagrelor group(n=85)and clopidogrel group(n=85).Platelet count and platelet inhibition rate(PIR)on 7d after PCI,incidence rates of major adverse cardio-and cerebrovascular events(MACCE)and hemorrhage during hospitalization and within six-month follow-up were observed and compared between two groups.Results:Compared with clopidogrel group on 7d after PCI,there was significant rise in adenosine diphosphate(ADP)platelet inhibition rate[(66.9±11.7)%vs.(86.5±9.4)%],and significant reduction in ADP-induced platelet-fibrinclot strength[MAADP,(52.0±4.1)mm vs.(39.3±4.6)mm]in ticagrelor group,P=0.001 both;the MACCE were no significant difference betweenclopidogrel group and ticagrelor group during hospitalization and within six-month follow-up,P=0.115;the incidence rate of hemorrhage in ticagrelor group was significantly higher than that of clopidogrel group(21.2%vs.9.4%),P=0.033.Conclusion:Ticagrelorpossesses better therapeutic effect than clopidogrel in aged patients during emergency PCI,but its bleeding risk rises.