替格瑞洛与氯吡格雷预防经皮冠状动脉介入术治疗患者微小心肌损伤效果的对比研究

Comparison of Efficacy of Ticagrelor and Clopidogrel in the Prevention of Minor Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention

目的:比较替格瑞洛与氯吡格雷预防经皮冠状动脉介入术(percutaneous coronary intervention,PCI)治疗患者发生微小心肌损伤(minor myocardial injury,MMI)、主要不良临床事件的效果。方法:选取2018—2019年于西安交通大学医学院第一附属医院接受PCI治疗的患者372例,根据随机数字表法将患者分为氯吡格雷组(n=186)与替格瑞洛组(n=186)。氯吡格雷组、替格瑞洛组患者术前分别采用氯吡格雷、替格瑞洛进行治疗。在基线期与术后12 h后检测并比较两组患者肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)水平;比较两组患者的临床预后指标,包括MMI、主要不良临床事件(死亡、PCI相关心肌梗死、脑卒中和短暂性脑缺血发作)发生情况以及住院时间等。根据是否发生MMI,将患者分为MMI组与非MMI组。比较MMI组与非MMI组患者的人口统计学、合并症、实验室指标、药物应用、冠脉支架植入位置、手术指标及病变类型等基线临床资料的差异。采用多变量Logistics回归分析,评价患者发生MMI的独立预测因子。结果:替格瑞洛组患者术后12 h较基线的变化值ΔcTnⅠ(t=17.281,P<0.001)、ΔCK-MB(t=14.604,P<0.001)较氯吡格雷组明显降低;替格瑞洛组患者MMI发病率较氯吡格雷组明显降低[18.8%(35/186)vs.32.8%(61/186),χ^2=9.491,P=0.002];替格瑞洛组患者的主要不良临床事件总发病率(χ^2=10.735,P=0.001)、心肌梗死发病率(χ^2=8.278,P=0.004)也均较氯吡格雷组明显降低,上述差异均有统计学意义。多因素分析结果显示,氯吡格雷治疗(OR=2.678,95%CI=1.147~6.239,P=0.028)、隐静脉移植血管干预(OR=3.682,95%CI=1.177~11.521,P=0.015)和C型病变(OR=1.246,95%CI=1.080~1.525,P=0.041)是MMI发病的独立预测因子。结论:替格瑞洛在降低PCI患者术后MMI和主要不良临床事件发病率方面较氯吡格雷更有效。

OBJECTIVE:To probe into the effects of ticagrelor and clopidogrel in the prevention of minor myocardial injury(MMI)and major adverse clinical events(MACE)in patients undergoing percutaneous coronary intervention(PCI).METHODS:Totally 372 patients undergoing PCI in the First Affiliated Hospital of Xi’an Jiaotong University from 2018 to 2019 were extracted to be divided into the clopidogrel group and the ticagrelor group via the random number table,with 186 cases in each group.Patients in the clopidogrel group and the ticagrelor group were respectively treated with clopidogrel and ticagrelor before surgery.Cardiac troponinⅠ(cTnⅠ)and creatine kinase isoenzyme(CK-MB)were detected and compared between two groups at baseline and 12 h after surgery.The clinical prognostic indicators of two groups were compared,including the incidence of MMI,MACE(death,PCI related myocardial infarction,stroke and transient ischemic attack)and length of stay.According to the occurrence of MMI,patients were divided into the MMI group and the non-MMI group.The baseline clinical data of patients in the MMI group and the non-MMI group were compared,including demography,complication,laboratory indicators,drug use,coronary stent implantation location,surgical indicators and lesion types.Multivariate Logistic regression analysis was used to evaluate the independent predictors of MMI.RESULTS:Changes from baseline in the ticagrelor group at 12 h after surgeryΔcTnⅠ(t=17.281,P<0.001)andΔCK-MB(t=14.604,P<0.001)were significantly lower than those in the clopidogrel group.The incidence of MMI in the ticagrelor group was significantly lower than that in the clopidogrel group[18.8%(35/186)vs.32.8%(61/186),χ^2=9.491,P=0.002].The incidence of MACE(χ^2=10.735,P=0.001)and myocardial infarction(χ^2=8.278,P=0.004)in the ticagrelor group was significantly lower than that in the clopidogrel group,with statistically significant differences.Multivariate analysis showed that clopidogrel treatment(OR=2.678,95%CI=1.147-6.239,P=0.028),saphenous vein implantation intervention(OR=3.682,95%CI=1.177-11.521,P=0.015)and type C lesions(OR=1.246,95%CI=1.080-1.525,P=0.041)were independent predictors of MMI.CONCLUSIONS:Ticagrelor is more effective than clopidogrel in reducing the incidence of MMI and MACE in patients undergoing PCI.