替格瑞洛在老年不稳定型心绞痛患者择期行经皮冠状动介入治疗中的疗效及安全性

Efficacy and safety of ticagrelor in the elderly patients with unstable angina undergoing elective percutenous coronary intervention

目的观察替格瑞洛在老年不稳定型心绞痛(UA)患者择期行经皮冠状动脉介入(PCI)治疗中的疗效及安全性。方法连续入选2014年1月至2015年12月于河北医科大学第二医院心内科初次就诊且年龄≥65岁的UA患者。根据随机数字表将入选患者分成氯吡格雷组(63例)和替格瑞洛组(65例)。替格瑞洛组患者入院后接受替格瑞洛180 mg负荷量,继之以90 mg每日两次维持;氯吡格雷组患者给予氯吡格雷组300 mg负荷剂量,以75 mg每日一次口服维持。记录所有患者入院、PCI术前的血小板聚集率(PAR),观察血小板高反应性(HPR)发生情况。所有患者均择期完成PCI手术,比较两组患者PCI术后TIMI血流和TIMI心肌灌注分级(TMPG)的变化。比较两组患者住院期间及出院后1个月内的主要心脏不良事件(MACE)及出血事件的发生情况。结果两组间患者基线资料如年龄、性别、吸烟史、高血压、糖尿病、血脂异常、缺血性卒中、GRACE评分、CRUSADE评分、BNP和肌酐水平等差异均无统计学意义(P>0.05)。两组患者介入途径、支架置入相关血管、术后心肌灌注水平和造影用量等差异均无统计学意义(P>0.05)。两组患者基线血小板参数(血小板计数、血小板分布宽度、平均血小板体积、PAR)差异均无统计学意义(P>0.05)。PCI术后1个月随访发现,两组患者PAR均较基线水平明显降低(均P<0.01),替格瑞洛组PAR下降更为明显(P<0.01),且替格瑞洛组HPR发生率明显低于氯吡格雷组(27.0%vs.3.1%,P<0.001)。替格瑞洛组MACE发生率明显低于氯吡格雷组(14.3%vs.1.5%,P=0.008)。两组患者出血并发症发生率差异无统计学意义(P>0.05),但是替格瑞洛组呼吸困难的发生率明显高于氯吡格雷组(0 vs.9.2%,P=0.028)。结论替格瑞洛在老年UA患者择期行PCI治疗中是安全有效的。

Objective To evaluate the efficacy and safety of ticagrelor in the elderly patients with unstable angina(UA) undergoing elective percutenous coronary intervention(PCI).Methods From January 2014 to December 2015,patients with UA and age≥65 year-old who were admitted to the Second Hospital of Hebei Medical University were enrolled in this study.All the patients were randomized into clopidogrel group(63 cases) and ticagrelor group(65 cases).Patients in clopidogrel group were received 300 mg clopidogrel followed by 75 mg per day.Patients in ticagrelor group were given 180 mg ticagrelor followed by 90 mg twice a day.The pre-PCI platelet aggregation rate and the creatinine of admission pre-PCI and post-PCI were recorded.All the patients underwent elective PCI.TIMI flow,and TIMI myocardial perfusion grade(TMPG) were compared.The major adverse cardiac events(MACE) and bleeding events were followed up for 1 month.Results The baseline clinical characteristics were similar between the two groups,including age,gender distribution,histories,GRACE score and CRUSADE score(P>0.05).No differences in interventional protocols were found(P>0.05).There were no differences in the baseline levels of platelet counts,platelet distribution width,mean platelet volume and platelet aggregation rate(PAR)(P>0.05).After 1-month follow-up,the levels of PAR were decreased in both groups(P<0.01),and it was much more lower in the ticagrelor group(27.0% vs.3.1%,P<0.001).The incidence of MACE was also lower in the ticagrelor group during the follow-up(14.3% vs.1.5%,P=0.008).The incidence of bleeding complications were not significantly different,but the incidence of dyspnea in the ticagrelor group was more than that in the clopidogrel group(0 vs.9.2%,P=0.028).Conclusion It is effective and safe of ticagrelor in the elder patients with UA undergoing elective PCI.