替格瑞洛治疗ST段抬高型心肌梗死行急诊经皮冠状动脉介入治疗患者的特征及疗效和安全性  

Baseline characteristics efficacy and safety of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention and treated with ticagrelor

作　　者：宋莉[1] 姚晶 周鹏[1] 刘臣[1] 谭宇[1] 盛兆雪 李健楠[1] 周金英[1] 陈润真 赵汉军[1] 颜红兵[1] SONG Li;YAO Jing;ZHOU Peng;LIU Chen;TAN Yu;SHENG Zhao-xue;LI Jian-nan;ZHOU Jin-ying;CHEN Run-zhen;ZHAO Han-jun;YAN Hong-bing(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心,北京100037 [2]鹤岗市人民医院心内二科

出　　处：《中国介入心脏病学杂志》2019年第10期561-566,共6页Chinese Journal of Interventional Cardiology

基　　金：中国医学科学院医学与健康科技创新工程(2016-I2M-1-009)

摘　　要：目的比较应用替格瑞洛和氯吡格雷治疗的ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗(PCI)患者的基线特征、疗效和安全性。方法入选2017年3月至2018年6月于中国医学科学院阜外医院行急诊PCI的STEMI患者537例。按入院时服用P2Y12抑制药的种类分为替格瑞洛组(299例)和氯吡格雷组(238例)。比较两组患者基线特征以及6个月主要不良心血管事件和出血风险。结果替格瑞洛组PCI史、支架内再狭窄和支架内血栓形成比例、使用抽吸导管和血小板糖蛋白Ⅱb/Ⅲa抑制药比例均偏高(均P<0.05)。替格瑞洛组合用的阿司匹林剂量偏低[(79.7±14.9)mg/d比(95.8±16.8)mg/d,P<0.001];而氯吡格雷组患者年龄偏大,体重偏轻,女性比例高,卒中比例高,血红蛋白、血小板计数和肌酐清除率水平偏低,心肌梗死溶栓治疗试验(TIMI)评分、全球急性冠状动脉事件注册(GRACE)评分和不稳定型心绞痛快速风险分层减少早期执行ACC/AHA指南的不良结果(CRUSADE)评分均偏高(均P<0.05)。logistic多因素回归分析显示,年龄(OR 0.960,95%CI 0.936~0.985,P=0.002)和PCI史(OR 1.849,95%CI 1.091~3.135,P=0.022)是入院时选择替格瑞洛治疗的独立预测因素。替格瑞洛组全因死亡、心肌梗死和缺血性卒中的联合终点发生率低于氯吡格雷组(3.0%比8.0%,P=0.016),而总体出血(35.5%比19.8%)和轻微出血(31.8%比13.5%)发生率显著高于氯吡格雷组(均P<0.001)。结论应用替格瑞洛治疗的STEMI急诊PCI患者比例已超过50%,年龄和PCI史是入院时选择替格瑞洛治疗的独立预测因素。替格瑞洛降低了缺血事件发生率,同时增加了出血发生率,但主要为轻微出血。Objective To compare the baseline characteristics and effi cacy safety in patients with STsegment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) and were treated with ticagrelor vs. clopidogrel. Methods STEMI patients(n=537) admitted to Fuwai Hospital and underwent primary PCI from March 2017 to June 2018 were divided into a ticagrelor group (n=299) and a clopidogrel group (n=238) based on regimen at admission. Patients baseline characteristics, major adverse cardiac events (MACEs) including all-cause death, myocardial infarction and ischemic stroke and bleeding events at 6 months were compared between the two groups. Results The history of PCI, the proportion of instent restenosis and stent thrombosis, the proportion of application of suction catheter and platelet glycoprotein Ⅱb/Ⅲa depressant ticagrelor group were higher, which indicated that the patients in ticagrelor group had higher coronary thrombus burden. The combined aspirin dose of ticagrelor group was lower than lopidogrel group [(79.7±14.9) mg/d vs.(95.8±16.8)mg/d,P<0.001]. And in the clopidogrel group, the patients were older, the weight was lighter, the proportion of women was higher, the proportion of stroke was higher, the levels of hemoglobin, platelet count and creatinine clearance rate were lower, thrombolysis in myocardial infarction TIMI score, global registered acute coronary events GRACE score and CRUSADE score were higher (both P<0.05), suggesting that the patients in clopidogrel group had higher total ischemic and bleeding risk evaluated by risk scores. Multivariable logistic analysis showed that age(OR 0.960,95%CI 0.936–0.985, P=0.002) and prior PCI hisotyr(OR 1.849,95%CI 1.091–3.135,P=0.022)were independent predictors of ticagrelor use at admission. The rate of MACEs was signifi cantly lower in the ticagrelor group than in the clopidogrel group at 6 months (3.0% vs. 8.0%,P=0.016). However,more total bleeding(35.5% vs. 19.8%) and minor bleeding (31.8% vs. 13.5%) were obser

关 键 词：心肌梗死 P2Y12抑制药 替格瑞洛 氯吡格雷 

分 类 号：R542.22[医药卫生—心血管疾病]