经皮冠脉介入术前应用替格瑞洛与氯吡格雷治疗急性ST段抬高型心肌梗死的效果比较

Comparison of the efficacy of Ticagrelor and Clopidogrel in the treatment of acute ST-segment elevation myocardial infarction before percutaneous coronary intervention

目的探讨经皮冠脉介入(PCI)术前应用替格瑞洛与氯吡格雷治疗急性ST段抬高型心肌梗死(STEMI)的效果比较。方法选取2015年1月至2019年2月武汉科技大学附属孝感医院收治的接受PCI治疗的112例STEMI患者作为研究对象,按照随机数字表法分为替格瑞洛组与氯吡格雷组,每组各56例。替格瑞洛组PCI术前给予替格瑞洛片,氯吡格雷组PCI术前给予硫酸氢氯吡格雷片。比较两组患者的PCI指标、术后24 h心肌酶学指标与N末端B型脑钠肽前体(NT-proBNP)水平的变化情况,随访6个月统计两组患者不良心血管事件(不良心血管事件)的发生率。结果替格瑞洛组患者TIMI血流分级优于氯吡格雷组,冠脉慢性血流发生率低于氯吡格雷组,差异有统计学意义(P<0.05);术后24 h两组患者肌钙蛋白I、磷酸肌酸激酶同工酶、NT-proBNP均低于治疗前,且替格瑞洛组肌钙蛋白I、磷酸肌酸激酶同工酶、NT-proBNP均低于氯吡格雷组,差异均有统计学意义(P<0.05);随访6个月,替格瑞洛组不良心血管事件总发生率低于氯吡格雷组,差异有统计学意义(P<0.05)。结论PCI术前应用替格瑞洛较应用氯吡格雷可更为良好地恢复患者冠脉血供,能够降低冠脉慢性血流发生率,减轻心肌损伤,具有降低预后不良心血管事件发生风险的明确功效。

Objective To compare the efficacy of ticagrelor and Clopidogrel in the treatment of acute ST-segment elevation myocardial infarction(STEMI)before percutaneous coronary intervention.Methods A total of 112 STEMI patients who received percutaneous coronary intervention(PCI)treatment in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2015 to February 2019 were selected as research objects,and they were divided into Ticagrelor group and Clopidogrel group according to random number table method,with 56 cases in each group.Ticagrelor group was given Ticagrelor Tablets before PCI,and Clopidogrel group was given Clopidogrel Bisulfate Tablets before PCI.The changes of PCI indexes,myocardial enzymology indexes and N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)level 24 h after operation were compared between the two groups.The incidence of adverse cardiovascular events in the two groups was calculated after 6 months follow-up.Results TIMI blood flow grading in Ticagrelor group was better than that in Clopidogrel group,the incidence of coronary chronic blood flow was lower than that in Clopidogrel group,and the differences were statistically significant(P<0.05).Troponin I,phosphocatine kinase isoenzyme and NT-proBNP 24 h after surgery in the two groups were lower than those before treatment,and the troponin I,phosphocatine kinase isoenzyme and NT-proBNP in Ticagrelor group were lower than those in Clopidogrel group,the differences were statistically significant(P<0.05).After 6 months of follow-up,the total incidence of adverse cardiovascular events in Ticagrelor group was lower than that in Clopidogrel group,and the difference was statistically significant(P<0.05).Conclusion Compared with clopidogrel,the application of tigrelor before PCI can better restore coronary blood supply,reduce the incidence of chronic coronary blood flow,reduce myocardial injury,and have a clear effect of reducing the risk of adverse cardiovascular events.