复杂冠状动脉病变介入治疗患者应用替格瑞洛的临床疗效观察  

Clinical therapeutic effect of ticagrelor for complicated coronary artery disease patients undergoing PCI

作　　者：曾丁邻 段雪莹[2] 范伟伟[1] 戴增欢[1] 李景辉[1] 陈劲松[1] 邓节喜[1] ZENG Ding-lin DUAN Xue-ying FAN Wei-wei et al(Department of Cardiology ,Chinese PLA No. 175 Hospital,Affiliated Southeast Hospital of Xiamen University ,Zhangzhou 363000, Fujian Province ,China)

机构地区：[1]解放军第一七五医院厦门大学附属东南医院心血管内科,漳州363000 [2]解放军第一七五医院厦门大学附属东南医院干部病房,漳州363000

出　　处：《中华老年心脑血管病杂志》2017年第8期825-828,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81601223)

摘　　要：目的评价复杂冠状动脉病变PCI患者应用替格瑞洛的有效性及安全性。方法选择2013年2月~2015年8月在我院心内科住院的复杂冠状动脉病变PCI患者204例,冠状动脉造影后随机分为替格瑞洛组98例和氯吡格雷组106例。替格瑞洛组术前给予替格瑞洛负荷剂量180mg口服,术后维持剂量90mg口服,2次/d;氯吡格雷组术前给予氯吡格雷负荷剂量300mg口服,术后维持剂量75mg口服,1次/d。观察术后12个月主要不良心血管事件(MACE),包括支架内血栓形成、再发心绞痛、再发心肌梗死和再次血运重建;安全性终点包括TIMI出血事件以及呼吸困难发生率。结果随访12个月,替格瑞洛组MACE发生率低于氯吡格雷组,但差异无统计学意义(14.3%vs 21.7%,P=0.170)。替格瑞洛组再发心肌梗死及支架内血栓形成发生率明显低于氯吡格雷组(1.0%vs6.6%,P=0.039;0vs 4.7%,P=0.029),呼吸困难发生率明显高于氯吡格雷组(6.1%vs 0.9%,P=0.042)。替格瑞洛组出血事件发生率较氯吡格雷组高,但差异无统计学意义(P=0.367)。结论复杂冠状动脉病变PCI患者应用替格瑞洛获益明显,与氯吡格雷比较进一步降低MACE,不增加出血风险,但呼吸困难发生率较高。Objective To assess the efficacy and safety of ticagrelor in complicated coronary artery disease（CAD）patients undergoing PCI.Methods Two hundred and four complicated CAD patients admitted to our hospital from February 2013 to August 2015 for PCI were divided into ticagrelor treatment group（n=98）and clopidogrel treatment group（n=106）.Patients in ticagrelor treatment group were treated with 180 mg oral ticagrelor before PCI and 90 mg oral ticagrelor（twice a day）after PCI while those in clopidogrel treatment group were treated with 300 mg oral clopidogrel before PCI and 75 mg oral clopidogrel（once a day）after PCI.The major adverse cardiovascular events（MACE）,including instent thrombosis,recurrent angina pectoris,recurrent myocardial infarction,revascularization,and incidence of TIMI bleeding events and dyspnea,were recorded 12 months after PCI.Results The incidence of MACE,recurrent myocardial infarction and instent thrombosis was lower while that of dyspnea and bleeding events was higher in ticagrelor treatment group than in clopidogrel treatment group during the 12-month follow-up period（P〈0.05）.Conclusion Ticagrelor is effective for complicated CAD patients undergoing PCI.The effect of ticagrelor is better than that of clopidogrel on MACE.Ticagrelor does not increase the risk of bleeding,but it leads to a higher incidence of dyspnea.

关 键 词：冠状动脉疾病 冠状血管造影术 支架 血小板聚集抑制剂 

分 类 号：R541.4[医药卫生—心血管疾病]