非ST段抬高型急性冠状动脉综合征患者延迟经皮冠状动脉介入术前使用非负荷剂量替格瑞洛的疗效和安全性  

Efficacy and safety of unloading dose of ticagrelor before delayed percutaneous coronary intervention in patients with non-ST segment elevation acute coronary syndromes

作　　者：吴淳[1] 杜胤龙 董雪[1] Wu Chun;Du Yinlong;Dong Xue(Department of Cardiology,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院心血管内科,518036

出　　处：《中国心血管杂志》2018年第4期294-298,共5页Chinese Journal of Cardiovascular Medicine

基　　金：广东省卫生和计划生育委员会医学科研基金项目(A2015569);深圳市科技创新委员会科研基金项目(JCYJ20150403091443272)~~

摘　　要：目的评价非ST段抬高型急性冠状动脉综合征(NSTEACS)患者行延迟经皮冠状动脉介入治疗(PCI)术前使用非负荷剂量替格瑞洛的疗效和安全性。方法本研究为前瞻性对照研究,入选2015年9月至2016年10月在北京大学深圳医院拟行延迟PCI的NSTEACS患者,由首诊医师自行决定是否使用替格瑞洛负荷剂量。观察组首次给予替格瑞洛90 mg,随后90 mg每日2次维持,对照组首次给予替格瑞洛180 mg负荷剂量,随后90 mg每日2次维持。两组均给予规范的冠心病药物治疗,并在24～72 h内行PCI。观察两组的有效性终点如术后1年内的心血管死亡、心肌梗死和卒中,以及安全性终点如主要出血、次要出血。结果观察组PCI术后4 h肌钙蛋白升高水平及术后1年内主要不良心脑血管事件(MACE)发生率与对照组相比,差异无统计学意义(P> 0. 05),观察组出血事件发生率与对照组相比,差异亦无统计学意义(P> 0. 05)。结论 NSTEACS患者延迟PCI术前使用或不使用负荷剂量替格瑞洛,疗效相当,出血发生率相当。Objective To evaluate the effectiveness and safety of ticagrelor with or without a loading starting dose before delayed percutaneous coronary intervention（PCI）in patients with non-ST segment elevation acute coronary syndrome（NSTEACS）. Methods This study was a prospective,controlled study.A total of 177 NSTEACS patients who underwent delay PCI were enrolled into this study in Peking University Shenzhen Hospital from September of 2015 to October of 2016.Loading strategy of ticagrelor was made by initial diagnosed physician.Starting dose of 90 mg of ticagrelor subsequent to 90 mg twice a day was prescribed in observation group,while starting dose of 180 mg of ticagrelor subsequent to 90 mg twice a day was prescribed in control group.Optimal medication was all prescribed in two groups and delayed PCI was performed in 24-72 hours.The major adverse cardiac events（MACE）include cardiac death,myocardial infarction and stroke and safety outcome include major bleeding and mild bleeding at 12 months after PCI. Results The level of troponin T elevation at 4 hours of post-PCI and MACE after 1 year did not show significant difference between two groups（ P 〉0.05）.Bleeding incidence did not show significant difference between two groups（ P 〉0.05）. Conclusions Effectiveness and bleeding risk are similar in NSTEACS patients with or without loading dose of ticagrelor who undergo delay PCI.

关 键 词：替格瑞洛 非负荷剂量 延迟经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]