氯吡格雷与替格瑞洛对冠状动脉旁路移植术后桥血管通畅性的影响比较

Effects of clopidogrel versus ticagrelor on graft patency after coronary artery bypass grafting

目的比较冠状动脉旁路移植术(CABG)后患者应用替格瑞洛联合阿司匹林与氯吡格雷联合阿司匹林治疗1年对桥血管通畅性的影响。方法收集2016年1月至2017年6月在首都医科大学附属北京安贞医院住院治疗,成功完成CABG,且术后给予双联抗血小板治疗的576例冠状动脉粥样硬化性心脏病患者的临床资料。根据术后双联抗血小板治疗用药分为替格瑞洛组(283例)与氯吡格雷组(293例)。比较2组患者治疗1年后桥血管通畅率、主要不良心血管事件(MACE)发生率和出血事件发生率。结果替格瑞洛组共完成随访264例,氯吡格雷组共完成随访269例。共计1 652支桥血管被评估,其中氯吡格雷组834支,替格瑞洛组818支。替格瑞洛组1年后桥血管通畅率与氯吡格雷组比较[88. 5%(724/818)比85. 5%(713/834)],差异无统计学意义(P=0. 068)。术后1年,2组患者MACE发生率比较,差异无统计学意义(P=0. 571)。替格瑞洛组非CABG相关出血事件发生率明显高于氯吡格雷组[19. 3%(51/264)比11. 5%(31/269)],差异有统计学意义(P=0. 013)。结论对于CABG术后双联抗血小板治疗的冠状动脉粥样硬化性心脏病患者,氯吡格雷与替格瑞洛在术后1年桥血管通畅率方面无明显差异,而对于患者远期预后及出血事件评估尚需进一步研究。

Objective To compare the effects of ticagrelor and aspirin versus clopidogrel and aspirin on1 year graft patency after coronary artery bypass grafting(CABG).Methods From January 2016 to June 2017,576 patients with coronary atherosclerotic heart disease were successfully treated by CABG in Beijing Anzhen Hospital,Capital Medical University,and received double antiplatelet therapy after operation.According to the antiplatelet regimen,the patients were divided into ticagrelor group(283 cases)and clopidogrel group(293 cases).Patency rate of bridge vessels,incidences of major adverse cardiovascular events(MACE)and bleeding events were analyzed 1 year after operation.Results Postoperative follow-up was completed in 264 cases in ticagrelor group and 269 cases in clopidogrel group.A total of 1 652 bridge vessels including 834 in clopidogrel group and 818 in ticagrelor group were assessed.There was no significant difference of the 1 year patency rate of bridge vessels between ticagrelor group and clopidogrel group[88.5%(724/818)vs 85.5%(713/834)](P=0.068).There was no significant difference of incidence of MACE between groups(P=0.571).Incidence of non-CABG-related bleeding events in ticagrelor group was significantly higher than that in clopidogrel group[19.3%(51/264)vs 11.5%(31/269)](P=0.013).Conclusions There is no significant difference between ticagrelor+aspirin and clopidogrel+aspirin on graft patency in 1 year after CABG.Further researches are needed to assess the long-term prognosis and bleeding risk.