不同程度冠状动脉病变ST段抬高型急性心肌梗死患者抗栓效果比较研究  

Comparison of Clinical Efficacy and Safety of Ticagrelor-based and Clopidogrel-based Antiplatelet Therapy in STEMI Patients with Different Degrees of Coronary Artery Disease

作　　者：曾春艳 纪征[2] 孙淑贤[2] 马威[2] 王兆翔[2] 贾风顺 ZENG Chun-yan;JI Zheng;SUN Shu-xian;MA Wei;WANG Zhao-xiang;JIA Feng-shun(North China University of Science and Technology,Tangshan 063000,China;The First Department of Cardiology,Tangshan Gongren Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学,河北省唐山市063000 [2]唐山工人医院心内一科,河北省唐山市063000

出　　处：《中国全科医学》2018年第12期1428-1431,1436,共5页Chinese General Practice

摘　　要：目的观察比较替格瑞洛与氯吡格雷治疗不同程度冠状动脉病变ST段抬高型急性心肌梗死(STEMI)患者的临床疗效及安全性。方法选取2013年1月—2015年7月唐山工人医院心内一科诊断为STEMI并行急诊冠状动脉造影检查的512例患者,均接受12个月以上的双联抗血小板治疗,最终完成12个月随访。将2014年5月—2015年7月入院确诊为STEMI并接受替格瑞洛联合阿司匹林治疗的患者作为研究组,共252例;将2013年1月—2014年4月入院确诊为STEMI并接受氯吡格雷联合阿司匹林治疗的患者作为对照组,共260例。根据Gensini评分将各组患者排序,根据中位数分为研究组高分亚组(n=126)、研究组低分亚组(n=126)、对照组高分亚组(n=130)、对照组低分亚组(n=130)。随访STEMI患者治疗12个月内主要不良心血管事件(MACE)、出血事件、心力衰竭发生情况。MCAE包括心源性死亡、心肌梗死、卒中、靶血管血运重建(TVR)、支架内血栓形成、再发心绞痛。出血事件包括轻微出血、次要出血、主要出血。结果研究组高分亚组MACE发生率[37.3%(47例)]低于对照组高分亚组[60.8%(79例)](χ~2=14.099,P<0.001)。研究组高分亚组出血事件发生率[32.5%(41例)]高于对照组高分亚组[20.0%(26例)](χ2=5.207,P<0.05);研究组高分亚组轻微出血发生率高于对照组高分亚组(P<0.05)。研究组高分亚组心力衰竭发生率低于对照组高分亚组(15.9%和27.7%,P<0.05)。研究组低分亚组与对照组低分亚组MACE发生率、出血事件发生率、心力衰竭发生率比较,差异均无统计学意义(P>0.05)。结论在冠状动脉病变较重的STEMI患者中替格瑞洛联合阿司匹林较氯吡格雷联合阿司匹林更能有效降低MACE、心力衰竭发生率,仅相对增加轻微出血风险;在冠状动脉病变较轻的STEMI患者中这两种抗血小板药物方案疗效及安全性相当。Objective To observe and compare the clinical efficacy and safety of ticagrelor and clopidogrel in the treatment of ST-segment elevation myocardial infarction(STEMI).Methods We included 512 patients who were diagnosed with STEMI and underwent emergency coronary angiography in the First Department of Cardiology,Tangshan Gongren Hospital from January 2013 to July 2015.All of the patients received dual-antiplatelet therapy for>12 months.Follow-up lasted 12 months.The study group consisted of 252 patients who were diagnosed with STEMI and received treatment with ticagrelor combined with aspirin between May 2014 and July 2015.The control group consisted of 260 patients who were diagnosed with STEMI and received treatment with clopidogrel combined with aspirin between January 2013 and April 2014.The patients were ranked according to Gensini score.With the median score as a cut‐off point,the patients were further divided into a study high-score subgroup(n=126),study low-score subgroup(n=126),control high-score subgroup(n=130)and control low-score subgroup(n=130).During 12-months follow up,major adverse cardiovascular events(MACE),bleeding events and heart failure were recorded.MACE included cardiogenic death,myocardial infarction,stroke,target vessel revascularization,stent thrombosis and recurrent angina.Bleeding events included mild,minor and major bleeding.Results The overall incidence of MACE in the study high-score subgroup(37.3%,47 cases)was significantly lower that in the control high-score subgroup(60.8%,79 cases)(χ2=14.099,P<0.001).The overall incidence of bleeding in the study high-score subgroup(32.5%,41 cases)was higher than that in the control high-score subgroup(20.0%,26 cases)(χ2=5.207,P<0.05),and the incidence of mild bleeding in the study high-score subgroup was higher than that in the control high-score subgroup(P<0.05).The incidence of heart failure in the study high-score subgroup was also significantly lower than that in the control high-score subgroup(15.9%vs.27.7%,P<0.05).There were no signifi

关 键 词：心肌梗死 替格瑞洛 氯吡格雷 疗效比较研究 药物不良反应 

分 类 号：R542.22[医药卫生—心血管疾病]