替格瑞洛对经皮冠状动脉介入治疗术后患者心肺功能影响

Effect of ticagrelor on cardiopulmonary function in patients after percutaneous coronary intervention

目的探讨使用替格瑞洛的经皮冠状动脉介入(PCI)术后患者的心肺功能是否存在改变。方法连续性纳入自2015年11月至2021年9月于北部战区总医院接受PCI治疗,且在出院前完成心肺运动试验(CPET)的3800例冠心病患者为研究对象。根据是否使用替格瑞洛将患者分为非替格瑞洛组(n=2574)与替格瑞洛组(n=1226)。使用倾向评分通过性别、年龄、体质量指数、既往PCI和陈旧性心肌梗死对两组研究人群进行1∶1倾向性评分匹配。收集并比较两组患者匹配前、后的人口学信息、既往病史、实验室检查结果、用药史,以及CPET相关指标。结果匹配后每组各1192例患者。匹配前,替格瑞洛组患者的体质量指数、心率、血红蛋白、N端B型钠尿肽原(NT-proBNP),以及男性、吸烟史、饮酒史、既往PCI、陈旧性心肌梗死占比均高于非替格瑞洛组;年龄、总胆固醇、收缩压、左室射血分数,以及卒中史占比均低于非替格瑞洛组,差异均有统计学意义(P<0.05)。匹配后,替格瑞洛组患者的心率、NT-proBNP、肌酸激酶同工酶高于非替格瑞洛组,左室射血分数、血红蛋白低于非替格瑞洛组,差异均有统计学意义(P<0.05)。匹配前,替格瑞洛组患者的无氧阈摄氧量、无氧阈代谢当量低于非替格瑞洛组,峰值氧脉搏、心率储备、运动中峰值舒张压高于非替格瑞洛组,差异均有统计学意义(P<0.05)。匹配后,替格瑞洛组患者的峰值摄氧量、无氧阈摄氧量、峰值代谢当量、无氧阈代谢当量、峰值氧脉搏低于非替格瑞洛组,差异均有统计学意义(P<0.05)。结论使用替格瑞洛的PCI术后患者心肺功能相对较差。

Objective To investigate the cardiopulmonary function changes in patients after percutaneous coronary intervention(PCI)with ticagrelor.Methods A total of 3800 patients with coronary heart disease who underwent PCI at General Hospital of Northern Theater Command from November 2015 to September 2021 and completed cardiopulmonary exercise test(CPET)before discharge were included in the study.Patients were divided into the non-ticagrelor group(n=2574)and the ticagrelor group(n=1226)according to whether or not they were using ticagrelor.Propensity score was used to match the two groups by sex,age,body mass index,previous PCI and old myocardial infarction.Demographic information,past medical history,laboratory results,medication history,and CPET related indicators were collected and compared between the two groups before and after matching.Results After matching,there were 1192 patients in each group.Before matching,the body mass index,heart rate,hemoglobin,N-terminal B-type natriuretic peptide(NT-proBNP),male,smoking history,drinking history,previous PCI and old myocardial infarction in ticagrelor group were higher than those in non-ticagrelor group,with statistical significance(P<0.05).Age,total cholesterol,systolic blood pressure,left ventricular ejection fraction and stroke history ratio were all lower than those in non-ticagrelor group,with statistical significance(P<0.05).After matching,the heart rate,NT-proBNP and creatine kinase isoenzyme in ticagrelor group were higher than those in non-ticagrelor group,and left ventricular ejection fraction and hemoglobin were lower than those in non-ticagrelor group,with statistical significance(P<0.05).Before matching,the anaerobic threshold oxygen uptake and anaerobic threshold metabolic equivalent in ticagrelor group were lower than those in non-ticagrelor group,and the peak oxygen pulse,heart rate reserve and peak diastolic blood pressure during exercise were higher than those in non-ticagrelor group,with statistical significance(P<0.05).After matching,the peak oxygen uptake,anaerobic threshold oxygen uptake,peak metabolic equivalent,anaerobic threshold metabolic equivalent and peak oxygen pulse in ticagrelor group were lower than those in non-ticagrelor group,with statistical significance(P<0.05).Conclusion The cardiopulmonary function of patients after PCI using ticagrelor is relatively poor.