普拉格雷在行经皮冠状动脉介入治疗的急性冠脉综合征患者中的应用效果

Application Effect of Prasugrel in Acute Coronary Syndrome Patients Treated by PCI

目的观察普拉格雷在行经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者中的应用效果。方法选取2013年11月—2014年7月在肇庆市第一人民医院心血管内科住院治疗的ACS患者62例,随机分为对照组和观察组,每组31例。两组患者均进行PCI,对照组患者于PCI术前3 d口服阿司匹林和氯吡格雷,术后继续口服氯吡格雷维持治疗1年;观察组患者于PCI术前3 d口服阿司匹林和普拉格雷,术后继续口服普拉格雷维持治疗1年。比较两组患者PCI术前及术后12 h血小板反应指数(PRI)、TIMI血流3级率和术后12 h PRI<50%者所占比例;两组患者出院后均随访1年,记录其主要终点事件、次要终点事件和联合终点事件发生情况。结果两组患者术前PRI、TIMI血流3级率比较,差异均无统计学意义(P>0.05);观察组患者术后12 h PRI低于对照组,术后12 h PRI<50%者所占比例高于对照组(P<0.05);而两组患者术后12 h TIMI血流3级率比较,差异无统计学意义(P>0.05)。两组患者主要终点事件发生率及发生风险比较、次要终点事件发生率及发生风险比较,差异均无统计学意义(P>0.05);而观察组患者联合终点事件发生率及发生风险均低于对照组(P<0.05)。结论普拉格雷能有效抑制血小板聚集,降低ACS患者术后联合终点事件发生率,具有较好的临床应用前景。

Objective To observe the application effect of prasugrel in acute coronary syndrome patients treated by PCI. Methods From November 2013 to July 2014,a total of 62 inpatients with acute coronary syndrome were selected in the Department of Cardiovascular Medicine,the First People' s Hospital of Zhaoqing,and they were randomly divided into control group and observation group,each of 31 cases. Patients of both groups received PCI after admission,patients of control group received oral aspirin combined with clopidogrel before 3 days of PCI,and continuously received oral clopidogrel for 1 year after PCI; patients of observation group received oral aspirin combined with prasugrel before 3 days of PCI,and continuously received oral prasugrel for 1 year after PCI. Platelet reactivity index( PRI) and the proportion of patients with 3-grade TIMI flow before PCI and after 12 hours of PCI,and the proportion of patients with PRI less than 50% were compared between the two groups;patients of the two groups were followed up for 1 year to observe the incidence of primary end point events,secondary end point events and clinical endpoints. Results No statistically significant differences of PRI or the proportion of patients with 3-grade TIMI flow was found between the two groups before PCI( P > 0. 05); after 12 hours of PCI, PRI of observation group was statistically significantly lower than that of control group,the proportion of patients with PRI less than 50% of observation group was statistically significantly higher than that of control group, while no statistically significant differences of the proportion of patients with 3-grade TIMI flow was found between the two groups( P > 0. 05). No statistically significant differences of incidence or occurrence risk of primary end point events or secondary end point events was found between the two groups( P >0. 05),while incidence and occurrence risk of clinical endpoints of observation group was statistically significantly lower than those of control group, respectively( P < 0. 05). Conclusion Prasugrel can effectively inhibit the platelet aggregation and reduce the incidence of clinical endpoints of acute coronary syndrome patients undergoing PCI,has relatively good application prospect on clinic.