不同剂量替格瑞洛在老年急性心肌梗死病人PCI术后抗血小板治疗中的有效性与安全性

Efficacy and safety of different doses of ticagrelor in elderly patients with acute myocardial infarction after percutaneous coronary intervention

目的比较低剂量替格瑞洛(180 mg负荷量,续贯60 mg每日2次口服)与标准剂量替格瑞洛(180 mg负荷量,续贯90 mg每日2次口服)在老年急性心肌梗死(AMI)病人经皮冠状动脉介入术(PCI)术后抗PLT治疗中的有效性与安全性。方法研究共入选196例成功接受PCI治疗的老年AMI病人,随机分为低剂量替格瑞洛组和标准剂量替格瑞洛组,详细记录病人住院期间及随访1年的主要不良心脑血管事件(MACCE)与出血事件。结果低剂量替格瑞洛组住院期间及随访至1年MACCE发生率与标准剂量替格瑞洛组相比,差异无统计学意义。住院期间2组小出血(8.4%比18.6%,P=0.061)和大出血发生率(1.1%比2.9%,P=0.622)差异无统计学意义;低剂量替格瑞洛组随访1年小出血发生率显著低于标准剂量替格瑞洛组(16.8%比36.9%,P=0.002),大出血方面2组差异无统计学意义(1.1%比3.9%,P=0.371)。Kaplan-Meier生存分析显示,低剂量替格瑞洛组1年无MACCE生存率与标准剂量替格瑞洛组相比,差异无统计学意义(P=0.823)。结论AMI病人PCI术后接受小剂量替格瑞洛较常规剂量相比,不增加MACCE事件发生率,同时可降低小出血风险。

Objective To compare the efficacy and safety of antiplatelet therapy in the patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI)between low-dose ticagrelor(180 mg loading,60 mg twice daily)and standard-dose ticagrelor(180 mg loading,90 mg twice daily).Methods A total of 196 patients with AMI who were successfully treated by PCI were randomly divided into low-dose ticagrelor group and standard-dose ticagrelor group.The major adverse cardio-cerebrovascular events(MACCE)and bleeding events during hospitalization and one-year follow-up were recorded in detail.Results There was no significant difference in MACCE between low-dose ticagrelor group and standard-dose ticagrelor group during hospitalization(10.5%vs 11.7%,P=0.825).The risk of minor bleeding(8.4%vs 18.6%,P=0.061)and major bleeding(1.1%vs 2.9%,P=0.622)were comparable between the two groups.Kaplan-Meier survival analysis showed that there was no significant difference in 1-year MACCE-free survival rate between low-dose ticagrelor group and standard-dose ticagrelor group(P=0.823).The risk of minor bleeding was significantly lower in low-dose ticagrelor group than that in standard-dose ticagrelor group(16.8%vs 36.9%,P=0.002)1 year after PCI,and there was no significant difference in major bleeding(1.1%vs 3.9%,P=0.371).Conclusions Compared with the routine dose,low-dose ticagrelor does not increase the incidence of MACCE,while reduce the risk of minor bleeding in the patients with AMI after PCI.