急性冠脉综合征PCI术前早期应用替格瑞洛对近期预后的影响  

Clinical benefits of Ticagrelor in patients with acute coronary syndrome before primary percutaneous coronary intervention

作　　者：张战文[1] 陈晖[1] 王宝玉[1] 邱春光[2] ZHANG Zhan-wen CHEN Hui WANG Bao-yu et al(Department of Emergency Cardiology, Zhengzhou Centre Hospital, Affiliated Hospital of Zhengzhou University, Zhengzhou 450007, Chin)

机构地区：[1]郑州大学附属郑州中心医院急诊心内科,河南省郑州市450007 [2]郑州大学第一附属医院心内科

出　　处：《中国心血管病研究》2016年第8期744-747,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨替格瑞洛在急性冠脉综合征患者急诊PCI术前应用的临床有效性及安全性.方法 将急救中心确诊急性冠脉综合征的160例患者随机分为治疗组和对照组,各80例患者.两组均接受急诊PCI术,治疗组于院前即口服负荷量替格瑞洛,对照组口服负荷量氯吡格雷.主要观察：①PCI手术前后梗死相关动脉TIMI血流;②住院期间出血并发症及继发血小板减少症的发生率;③术后6个月的心血管主要不良事件（MACE）发生情况.结果 两组患者临床基本资料无明显差异.替格瑞洛组术前梗死相关动脉TIMI 0～1级与氯吡格雷组比较差异有统计学意义（67.5％比60.0％,P＜0.05）,两组PCI术前TIMI 3级比较未见统计学差异（17.5％比12.5％,P＞0.05）,两组PCI术后TIMI 3级比较差异有统计学意义（95.0％比85.0％,P＜0.05）.术后1周超声心动图提示氯吡格雷组LVEF低于替格瑞洛组（P＜0.05）.术后替格瑞洛组轻度出血事件较对照组略有增多,但两组比较未见统计学差异（P＞0.05）;两组近期MACE发生率比较未见统计学差异（P＞0.05）.结论 急性冠脉综合征患者急诊行PCI术前早期应用替格瑞洛能改善术后心肌再灌注,挽救濒死心肌,恢复存活心肌细胞功能,改善心功能,且未明显增加出血事件及主要心血管不良事件,是有效和安全的.Objective To observe the clinical benefits of Ticagrelor（ADP receptor antagonist） in patients with acute coronary syndrome（ACS） before primary PCI. Methods 160 patients with ACS diagnosed by emergency centre were being treated by primary PCI, and randomly divided into Ticagrelor group（n=80） and control group （n=80）. To assess TIMI grade flow of infarct-related artery （IRA） before and after PCI. To record the incidences of the bleeding complications and thrombocytopenia during hospitalization. To follow up the major adverse cardial events rates 6 month after PCI. Results TIMI grade 0-1 flow of IRA in control group at initial angiography before PCI was significantly higher than that in Ticagrelor group（67.5% vs 60.0%, P〈0.05）. There were no difference in TIMI grade 3 flow before PCI between two groups （17.5% vs 12.5%, P〉0.05）. TIMI grade 3 flow in Ticagrelor group was higher than that in control group after PCI （95.0% vs 85.0%, P〈0.05）. There were no difference in TIMI grade 0-1 flow after PCI between two groups （2.5% vs 6.25%, P〉0.05）. LVEF in control group was lower than that in Ticagrelor group （P〈0.05）. Hemorrhage rate in Ticagrelor group was higher, but there was no differ- ence between two groups （P〉0.05）. The incidence of MACE in control group was higher than that in Ticagrelor group, but there was no difference（P〉0.05）. Conclusion Administration of Ticagrelor before primary PCI on pa- tients with ACS can make better the myocardial reperfusion, retrieve the moribund myocardium, recover survival function, improve the heart function. It does not increase the hemorrhage rate and the incidence of MACE, it is safe and effective.

关 键 词：急性冠脉综合征 经皮冠状动脉介入治疗 替格瑞洛 氯吡格雷 

分 类 号：R543.3[医药卫生—心血管疾病]