急性心肌梗死多支病变患者PCI术前应用替格瑞洛与氯吡格雷的效果比较

Effect of ticagrelor versus clopidogrel before PCI on patients with acute myocardial infarction multi-vessel lesions

目的对比分析急性心肌梗死(AMI)多支病变患者经皮冠状动脉介入治疗(PCI)术前应用替格瑞洛与氯吡格雷的效果。方法回顾性抽取2021年8月至2023年8月在解放军联勤保障部队第九九〇医院收集的病例进行研究,将70例符合抽取标准的AMI多支病变患者按照随机数字表法分为替格瑞洛组(35例)与氯吡格雷组(35例)。两组均行PCI治疗,氯吡格雷组术前应用氯吡格雷,替格瑞洛组术前应用替格瑞洛。比较两组血小板聚集率、心肌梗死溶栓治疗(TIMI)血流分级、心功能[左心室射血分数(LVEF)、左心室收缩期末容量(LVESV)]、心肌酶水平[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)]、血流动力学[平均血流速度(Vm)、阻力指数(RI)]。结果术后3、7 d,替格瑞洛组血小板聚集率低于氯吡格雷组(P<0.05)。术后1个月,替格瑞洛组TIMI血流分级优于氯吡格雷组(P<0.05)。术后1个月,替格瑞洛组LVEF高于氯吡格雷组,LVESV低于氯吡格雷组(P<0.05)。术后1个月,替格瑞洛组CK、CK-MB、cTnI低于氯吡格雷组(P<0.05)。术后1个月,替格瑞洛组Vm高于氯吡格雷组,RI低于氯吡格雷组(P<0.05)。结论与氯吡格雷比较,AMI多支病变患者PCI术前应用替格瑞洛可更有效地抑制血小板聚集,改善血流情况和心功能。

ObjectiveTo compare and analyze the effects of ticagrelor and clopidogrel before percutaneous coronary intervention(PCI)on patients with acute myocardial infarction(AMI)with multi-vessel lesions.MethodsCases were collected from No.990 Hospital of the Joint Logistic Support Force from August 2021 to August 2023,and 70 patients with AMI multi-vessel lesions who met the inclusion criteria were divided into the ticagrelor group(35 cases)and the clopidogrel group(35 cases)by random number table method.Both groups were treated by PCI;before surgery,the clopidogrel group was treated with clopidogrel,and the ticagrelor group was treated with ticagrelor.Platelet aggregation rate,Thrombolysis in Myocardial Infarction(TIMI)flow grade,cardiac function assessed by left ventricular ejection fraction(LVEF)and left ventricular end-systolic volume(LVESV),levels of cardiac enzymes including creatine kinase(CK),creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnI),hemodynamics including mean blood flow velocity(Vm)and resistance index(RI)were compared between the two groups.ResultsAt 3 and 7 days after surgery,the platelet aggregation rates in the ticagrelor group were lower than those in the clopidogrel group(P<0.05).One month after surgery,the TIMI flow grade of the ticagrelor group was better than that of the clopidogrel group(P<0.05).One month after surgery,the ticagrelor group had higher LVEF and lower LVESV compared with the clopidogrel group(P<0.05).One month after surgery,levels of CK,CK-MB and cTnI in the ticagrelor group were lower than those in the clopidogrel group(P<0.05).One month after surgery,the ticagrelor group had higher Vm and lower RI compared with the clopidogrel group(P<0.05).ConclusionsCompared with clopidogrel,pre-PCI application of ticagrelor in patients with AMI multi-vessel lesions can inhibit platelet aggregation more effectively,and improve blood flow and cardiac function.