氯吡格雷150mg与三联抗血小板对急性前壁心肌梗死PCI患者的疗效比较

Efficacy of 150 mg clopidogrel and triple antiplatelet in patients with acute anterior myocardial infarction undergoing PCI

目的观察150mg氯吡格雷与三联抗血小板对急性前壁心肌梗死并行经皮冠脉介入治疗(percutaneous coronary intervention,PCI)治疗患者的疗效比较及安全性。方法入选50例的急性前壁心肌梗死并行经皮冠脉介入治疗的老年患者,术后随机分为150 mg氯吡格雷治疗组(阿司匹林100 mg qd+氯吡格雷150 mg qd)和三联抗血小板治疗组(西洛他唑100 mg bid+阿司匹林100 mg qd+氯吡格雷75 mg qd),6个月后复查造影观察血管病变,并评价心血管事件和药物安全性。结果 2组术后即刻靶病变处直径(2.75±0.29 mm vs.2.69±0.31 mm)差异无统计学意义,三联抗血小板组较150 mg氯吡格雷组靶病变晚期血管丢失(late lumen loss,LLL)(0.22±0.46 mm vs.0.38±0.65 mm)与靶病变血运重建(target lesion reconstruction,TLR)率(8%vs.24%)差异均无统计学意义,但2项指标均有一定程度改善。2组主要心血管不良事件(major adversecardiovascular event,MACE)和出血情况的对比,差异无统计学意义。结论三联抗血小板药物治疗可以在一定程度上减少晚期血管丢失、降低靶病变血运重建率,而且不增加出血和不良心血管事件。

Objective To observe the efficacy and safety of 150 mg clopidogrel and triple antiplatelet in acute anterior myocardial infarction ( AMI) patients undergoing percutaneous coronary intervention ( PCI).Methods Totally 50 patients who had been diagnosed as acute anterior myocardial infarction and prepared to PCI treatment were randomly divided into two groups:150 mg clopidogrel group ( asprin 100 mg/d qd+clopidogrel 150 mg/d qd) and triple antiplatelet group ( cilostazol 100 mg bid+asprin 100 mg/d qd+clopidogrel 75 mg/d qd).The coronary lession through CAG, incidence of major cardiovascular events and safety in 6 months were observed and assessed.ResuIts There was no significant difference in level of target lesion diameter between two groups after PCI instantly (2.75 ±0.29 mm vs.2.69 ±0.31 mm).There were no significant differences of late lumen loss (LLL) and target lesion revascularization (TLR) between triple antiplatelet group and 150 mg clopidogrel group (0.22 ±0.46 mm vs.0.38 ±0.65 mm; 8%vs.24%) , but the two indexes were improved in a certain extent.There were no significant differences in hemorrhage and major adverse cardiovascular events ( MACE) between two groups.ConcIusion The triple antiplatelet therapy could reduce the late lumen loss and target lesion revascularization, and not increase hemorrhage and adverse cardiovascular events.