替格瑞洛联合PPIs治疗行急诊PCI术的急性STEMI患者的疗效

Efficacy of ticagrelor combined with PPIs in acute STEMI patients underwent emergency PCI

目的观察替格瑞洛联合质子泵抑制剂(PPIs)治疗行急诊经皮冠状动脉介入治疗(PCI)术的急性ST段抬高型心肌梗死(STEMI)患者的疗效。方法首次发生并行急诊PCI治疗的急性STEMI患者90例分为三组:A组30例,采用替格瑞洛联合泮托拉唑治疗;B组30例,采用替格瑞洛联合奥美拉唑治疗;C组30例仅采用替格瑞洛治疗。观察三组患者心肌微循环灌注情况,记录PCI术后支架内血栓发生率以及缺血、出血终点事件发生情况,检测P-选择素、血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)、肌酸激酶同工酶MB(CK-MB)、肌钙蛋白I(cTnI)和B型脑利钠肽(BNP)水平。结果各组患者心肌梗死溶栓治疗(TIMI)血流分级比较无统计学差异(P>0.05)。各组均未发生确定或可能的急性和亚急性支架内血栓。各组患者P-选择素、GPⅡb/Ⅲa、CK-MB、cTnI和BNP在入院即刻、服药后24 h和服药后第7天无统计学差异(P>0.05)。各组患者在90 d内均未发生缺血终点事件;A组无出血终点事件发生,B组发生其他组织器官出血事件1例,C组发生消化道出血事件2例,发生其他组织器官出血事件1例。C组消化道出血事件发生率稍高于A、B组(P>0.05)。结论对于行急诊PCI术治疗的急性STEMI患者,替格瑞洛联合PPIs治疗不影响心肌再灌注,不增加支架内血栓发生率,且不增加缺血、出血事件的发生风险。

Objective To observe the efficacy of ticagrelor combined with proton pump inhibitors(PPIs)in acute ST-segment elevation myocardial infarction(STEMI)patients underwent emergency percutaneous coronary intervention(PCI).Methods Ninety patients with first onset acute STEMI were divided into three groups with 30 cases each,who were treated with ticagrelor and pantoprazole(group A),ticagrelor and omeprazole(group B)or ticagrelor(group C).The myocardial microcirculation perfusion was observed and the incidence of stent thrombosis and occurrence of ischemic and bleeding endpoint events after PCI were recorded.The levels of P selectin,platelet glycoproteinⅡb/Ⅲa(GPⅡb/Ⅲa),creatine kinase isoenzyme MB(CK-MB),troponin I(cTnI)and brain natriuretic peptide(BNP)were detected.Results The thrombolysis in myocardial infarction(TIMI)blood flow classification was not different among the three groups(P>0.05).No definite or probable acute or subacute stent thrombosis occurred in the three groups.The levels of P selectin,GPⅡb/Ⅲa,CK-MB,cTnI and BNP of three groups were similar after admission,24 hours and 7 days after medication(P>0.05).No ischemic endpoint events occurred within 90 days after PCI.No bleeding endpoint event occurred in group A.One case in group B had bleeding from other tissues and organs.Two cases had gastrointestinal bleeding events and one case had bleeding from other tissues and organs in group C.The incidence of gastrointestinal bleeding in group C was slightly higher than that in groups of A and B(P>0.05).Conclusion In the acute STEMI patients underwent emergency PCI,the treatment of ticagrelor combined with PPIs has no effect on myocardium perfusion and does not increase the incidence of stent thrombosis and the risk of ischemic and bleeding events.