替格瑞洛与氯吡格雷抗血小板治疗对急性冠脉综合征患者PCI术后QT离散度及心血管事件的影响

Effects of Ticagrelor and Clopidogrel Antiplatelet Therapy on QT Dispersion and Cardiovascular Events in Patients with Acute Coronary Syndrome after PCI

目的探究行经皮冠状动脉介入术(PCI)的急性冠脉综合征(ACS)患者,应用替格瑞洛与氯吡格雷抗血小板治疗对QT离散度(QTd)及心血管事件的影响。方法选择行PCI治疗的90例ACS患者,分为观察组和对照组,各45例。对照组患者应用氯吡格雷+阿司匹林,观察组患者应用替格瑞洛+阿司匹林,比较两组患者血小板聚集功能、心功能与心肌损伤情况、QT离散度及不良心血管事件(MACE)发生情况。结果术后24 h,两组患者NT-proBNP、CK-MB、cTnI水平较术前降低(P<0.05),且观察组低于对照组(P<0.05);术后3个月内,两组患者MPAR、PRU水平下降(P<0.05),且观察组患者治疗后24 h、1个月、3个月的MPAR、PRU水平均低于对照组(P均<0.05);术后24 h,两组患者QTd值较术前降低,且观察组低于对照组(P<0.05);随访至术后6个月,观察组MACE发生率(8.89%)低于对照组(24.44%)(P<0.05)。结论ACS患者PCI术前、术后均应用替格瑞洛抗血小板治疗较应用氯吡格雷具有更快、更强的抑制血小板聚集效果,更有利于减轻心肌损伤、缩短QTd值,减少MACE发生率。

Objective To explore the effects of ticagrelor and clopidogrel antiplatelet therapy on QT dispersion(QTd)and cardiovascular events in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods Ninety patients with ACS who planned to undergo PCI in our hospital were selected.Control group was treated with clopidogrel+aspirin while observation group was treated with ticagrelor+aspirin.Platelet aggregation function,cardiac function and myocardial damage,QT dispersion and occurrence of major adverse cardiovascular events(MACE)were compared between the two groups.Results At 24 h after surgery,the levels of NT-proBNP,CK-MB and cTnI in the two groups were decreased compared with those before surgery(P<0.05),and the levels in observation group were lower than those in control group(P<0.05).Within 3 months after surgery,the levels of MPAR and PRU in the two groups were decreased(P<0.05).The levels of MPAR and PRU at 24 h,1 month and 3 months after surgery in observation group were lower than those in control group(P all<0.05).At 24 h after surgery,the QTd value in the two groups was decreased compared with that before surgery(P<0.05),and the value in observation group was lower than that in control group(P<0.05).Follow-up was performed until 6 months after surgery,and the incidence rate of MACE was 8.89%in observation group and 24.44%in control group(P<0.05).Conclusion Ticagrelor anti-platelet therapy for patients with ACS before and after PCI has faster and stronger inhibition of platelet aggregation than clopidogrel,and the former one is more conducive to relieving myocardial damage,shortening QTd value and reducing the incidence rate of MACE.