替格瑞洛对ST段抬高型心肌梗死病人经皮冠状动脉介入治疗后心肌微循环、心功能、不良心血管事件发生情况的影响

Effects of tigrilol on myocardial microcirculation,cardiac function and adverse cardiovascular events after PCI in STEMI patients

目的探讨替格瑞洛对ST段抬高型心肌梗死(STEMI)病人经皮冠状动脉介入治疗(PCI)后心肌微循环、心功能、不良心血管事件发生情况的影响。方法2017年8月至2018年7月间在北京大学深圳医院接受治疗的STEMI病人112例,按随机数字表法将其分为替格瑞洛组、氯吡格雷组,各56例。替格瑞洛组接受PCI术前及术后替格瑞洛干预,氯吡格雷组接受PCI术前及术后氯吡格雷干预。均持续干预12个月。对比两组病人的血小板聚集率、心肌微循环参数[造影剂开始灌注时间(AT)、灌注峰值强度(PI)、灌注达峰时间(APT)]、心功能参数[左室射血分数(LVEF)、心脏指数、每搏输出量指数(SVI)]、主要不良心血管事件(MACE)[心源性猝死、非致死性急性再梗死、靶血管再次血运重建]发生情况的差异。结果PCI术后24 h、术后1周,替格瑞洛组血小板聚集率[(30.26±4.73)%、(27.23±4.23)%]低于氯吡格雷组病人[(37.11±4.65)%、(32.04±4.81)%](P<0.05)。术后1周,替格瑞洛组AT、APT水平[(2.21±0.26)s、(2.63±0.29)s]低于氯吡格雷组[(2.50±0.28)s、(3.20±0.38)s],PI的水平(6.31±0.73)dB高于氯吡格雷组(6.01±0.74)dB;LVEF、心脏指数、SVI水平[(55.17±6.23)%、(3.52±0.46)L·min^(−1)·m^(−2)、(57.42±6.89)mL/m^(2)]均高于氯吡格雷组[(52.65±6.59)%、(3.10±0.37)L·min^(−1)·m^(−2)、(51.07±6.33)mL/m^(2)](均P<0.05)。PCI后30d内,两组病人的MACE总发生率及心源性猝死、非致死性急性再梗死、靶血管再次血运重建发生率的差异无统计学意义(P>0.05)。结论替格瑞洛在改善STEMI病人PCI后心肌微循环、提升心功能方面具有优势,其在减少MACE发生率方面的作用尚不显著。

Objective To investigate the effects of tigrilol on myocardial microcirculation,cardiac function and adverse cardiovascu⁃lar events after PCI in STEMI patients.Methods One hundred and twelve cases of STEMI patients undergoing treatment in Peking University Shenzhen Hospital from August 2017 to July 2018 were assigned into tigrilol group and clopidogrel group by random number table method,each with 56 cases.Patients in tigrilol group were treated with tigrilol intervention before and after PCI,while those in clopidogrel group were treated with clopidogrel intervention before and after PCI.Both groups received intervention for 12 months.A comparison was made between the groups of platelet aggregation rate,myocardial microcirculation parameters[perfusion time of the contrast agents(AT),peak intensity(PI)and perfusion peak time(APT)],cardiac function parameters[left ventricular ejection fraction(LVEF),cardiac index(CI),stroke volume index(SVI)],and major adverse cardiac events(MACE)[sudden cardiac death,nonfatal acute reinfarction,target vessel revascularization].Results Twenty four hours after PCI and 1 week after PCI,the platelet aggregation rates[(30.26±4.73)%,(27.23±4.23)%]of the ticagrelor group were lower than those of the clopidogrel group[(37.11±4.65)%,(32.04±4.81)%](P<0.05).One week after operation,the levels of AT and APT[(2.21±0.26)s,(2.63±0.29)s]in the ticagrelor group were lower than those in the clopidogrel group[(2.50±0.28)s,(3.20±0.38)s],and the level of PI was higher than that in the clopidogrel group[(6.31±0.73)dB vs.(6.01±0.74)dB];LVEF,CI,and SVI levels[(55.17±6.23)%,(3.52±0.46)L·min^(−1)·m^(−2),(57.42±6.89)mL/m^(2)]were high⁃er than those in the clopidogrel group[(52.65±6.59)%,(3.10±0.37)L·min^(−1)·m^(−2),(51.07±6.33)mL/m^(2)](all P<0.05).Within 30 days after PCI,the total incidence of MACE and the incidences of sudden cardiac death,non-fatal acute reinfarction,and target vessel revascular⁃ization were not statistically different between the two groups(P>0.05).Conclusion Tigrilol has advantages in improving myocardial microcirculation and cardiac function after PCI in STEMI patients,but its effect on reducing MACE incidence is not significant.