高体质量指数急性冠状动脉综合征患者中应用替格瑞洛与氯吡格雷安全性及有效性比较

Safety and efficacy of ticagrelor versus clopidogrel in patients with acute coronary syndrome with high body mass index

目的 比较在高体质量指数(BMI)的急性冠状动脉综合征(ACS)患者中应用替格瑞洛与氯吡格雷的安全性及有效性。方法 选取北部战区总医院心血管内科自2016年3月至2019年3月收治的3 140例高BMI的ACS患者为研究对象。根据药物使用情况将患者分为氯吡格雷组(n=1 877)与替格瑞洛组(n=1 263)。采用倾向性评分匹配方法,对两组患者进行1∶1匹配校正组间差异。记录并比较倾向性评分匹配前后两组患者的一般资料、手术资料、出院后用药情况,以及不良事件发生情况。结果 倾向性评分匹配前,氯吡格雷组患者年龄、左心室射血分数,以及高血压、既往脑卒中、贫血、心源性死亡、全因死亡比例均高于替格瑞洛组,BMI、肾小球滤过率、支架数量、支架长度,以及男性、靶血管位置左主干与左前降支、使用血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体拮抗剂比例均低于替格瑞洛组,差异均有统计学意义(P<0.05);两组患者吸烟情况、冠心病诊断类型比较,差异均有统计学意义(P<0.05)。倾向性评分匹配后,两组患者一般资料、手术资料、出院后用药情况比较,差异均无统计学意义(P>0.05);氯吡格雷组患者全因死亡发生率高于替格瑞洛组,差异有统计学意义(P<0.05)。结论 高BMI的ACS患者应用替格瑞洛会减少全因死亡的发生。

Objective To compare the safety and efficacy of ticagrelor versus clopidogrel in patients with acute coronary syndrome(ACS)with high body mass index(BMI).Methods A total of 3 140 patients with high BMI with ACS admitted to the Department of Cardiology of General Hospital of Northern Theater Command from March 2016 to March 2019 were selected as the study objects.Patients were divided into clopidogrel group(n=1 877)and ticagrelor group(n=1 263) according to drug use.The bias score matching method was used to adjust the difference between the two groups by 1∶1 matching.The general data, surgical data, drug use after discharge, and the occurrence of adverse events were recorded and compared between the two groups before and after propensity score matching.Results Before matching the propensity score, age, left ventricular ejection fraction, hypertension, previous stroke, anemia, cardiac death and all-cause death in clopidogrel group were higher than those in ticagrelor group and the BMI,glomerular filter rate, number of stents, length of stents and male, left main and left anterior descending branches of target vessels, proportion of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers were lower than those in ticagrelor group, with statistical significance(P<0.05).There were significant differences in smoking and coronary heart disease diagnosis types between the two groups(P<0.05).After matching the propensity score, there was no statistical significance in the general information, surgical information and drug use after discharge between the two groups(P>0.05),and the incidence of all-cause death in clopidogrel group was higher than ticagrelor group, and the difference was statistically significant(P<0.05).Conclusion The use of ticagrelor in high BMI patients with ACS can reduce the occurrence of all-cause death.