氯吡格雷及替格瑞洛对老年急性冠脉综合征患者的疗效与安全性探讨

Curative effects and safety of clopidogrel and ticagrelor on senile acute coronary syndrome

目的探讨氯吡格雷与替格瑞洛联合阿司匹林的双联抗血小板治疗(DAPT)对老年及高龄老年急性冠脉综合征(ACS)患者的疗效和安全性。方法选择急诊经皮冠状动脉介入治疗(PCI)的老年ACS患者479例,随机分为老年氯吡格雷组(A组)172例、老年替格瑞洛组(B组)161例、高龄老年氯吡格雷组(C组)79例和高龄老年替格瑞洛组(D组)67例,分别应用氯吡格雷和替格瑞洛联合阿司匹林的DAPT,观察PCI后TIMI血流分级、心肌灌注分级(TMPG)、主要并发症及1年随访出血事件和主要终点的变化。结果替格瑞洛组(B组和D组)PCI后TIMI 3级血流、TMPG 3级心肌灌注显著高于氯吡格雷组(A组和C组,P<0.05),梗死后心绞痛、严重心律失常和KillipⅢ级以上心功能的发生率显著低于氯吡格雷组(A组和C组,P<0.05);总出血和中度出血的发生率高于氯吡格雷组(A组和C组,P<0.05)严重出血的发生率高龄老年替格瑞洛组(D组)高于老年氯吡格雷组(A组,P<0.05);高龄老年组(C组和D组)主要终点和全因死亡的发生率高于老年组(A组和B组,P<0.05);次要有效终点高于老年氯吡格雷组(A组,P<0.05)。结论与氯吡格雷对比:替格瑞洛可改善老年和高龄老年ACS患者PCI后心肌血流灌注,减少缺血并发症的发生,但出血并发症较高。

Objective To discuss the curative effects and safety of clopidogrel or ticagrelor combined with aspirin in dual antiplatelet therapy(DAPT)in aged and advanced-aged patients with acute coronary syndrome(ACS).Methods The elderly ACS patients undergone emergency PCI(n=479)were chosen and divided into aged clopidogrel group(group A,n=172),aged ticagrelor group(group B,n=161),advanced-aged clopidogrel group(group C,n=79)and advanced-aged ticagrelor(group D,n=67).DAPT of clopidogrel combined with aspirin and DAPT of ticagrelor combined with aspirin were respectively administrated,and changes of TIMI flow grades,TIMI myocardial perfusion grade(TMPG),major complications and bleeding events and major end-point events were observed after PCI.Results TIMI flow grade 3 and TMPG 3 after PCI were significantly higher in groups B and D than those in groups A and C(P<0.05).The incidence rates of post-infarction angina pectoris,severe arrhythmia and Killip gradeⅢwere significantly lower in groups B and D than those in groups A and C(P<0.05).The incidence rates of total bleeding events and medium bleeding were higher in groups B and D than those in groups A and C(P<0.05),and incidence rate of severe bleeding was higher in group D than that in group A(P<0.05).The incidence rates of major end-point events and all-cause mortality were higher in groups C and D than those in groups A and B(P<0.05).The incidence rate of secondary end-point events was higher in groups C and D than that in group A(P<0.05).Conclusion Compared with clopidogrel,ticagrelor can relieve myocardial flow perfusion,reduce ischemia complications but increase bleeding complications in aged and advance-aged patients with ACS.