氯吡格雷与替格瑞洛对老年非ST段抬高急性冠状动脉综合征安全性和疗效的对比研究  

Safety and efficacy of clopidogrel and ticagrelor in elderly patients with non-ST segment elevation acute coronary syndrome

作　　者：齐静[1] 陈韦[1] 于乐[1] 裘淼涵 李超 周鑫[1] 于开锋[1] 刘仕利[1] 侯平[1] Qi Jing;Chen Wei;Yu Le;Qiu Miaohan;Li Chao;Zhou Xin;Yu Kaifeng;Liu Shili;Hou Ping(No.2 Department of Cardiology,Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110032,Liaoning Province,China)

机构地区：[1]辽宁中医药大学附属医院心内二科,沈阳110032 [2]北部战区总医院心内科 [3]北部战区总医院急诊科

出　　处：《中华老年心脑血管病杂志》2020年第12期1259-1262,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81874403);辽宁省自然科学基金(20180550907,20170540599);辽宁省“兴辽英才计划”项目(XLYC1802099)。

摘　　要：目的对比分析替格瑞洛与氯吡格雷对老年非ST段抬高急性冠状动脉综合征(NSTACS)患者的安全性和临床疗效。方法回顾性分析行PCI的年龄>65岁的NSTACS患者553例,根据住院期间应用药物情况分为氯吡格雷组374例和替格瑞洛组179例,随访12个月,对比分析2组出血情况、主要心脑血管事件(MACCE)和呼吸困难发生率。结果随访12个月替格瑞洛组全部出血及呼吸困难发生率明显高于氯吡格雷组(22.9%vs 9.4%,P=0.000;1.7%vs 0,P=0.034)。2组MACCE发生率及大出血发生率比较,无统计学差异(P>0.05)。Kaplan-Meier生存曲线分析显示,双联抗血小板治疗(DAPT)3个月,替格瑞洛组全部出血发生率高于氯吡格雷组(15.6%vs 2.4%,Plog-rank<0.01)。DAPT 3~12个月,替格瑞洛组与氯吡格雷组全部出血发生率比较,无统计学差异(Plog-rank>0.05)。COX回归分析显示,混杂因素校正后,DAPT 3个月内应用替格瑞洛出血风险是氯吡格雷的6.277倍(95%CI:2.668~14.767,P=0.000),DAPT 3~12个月应用替格瑞洛的出血风险是氯吡格雷的1.726倍(P>0.05)。结论与氯吡格雷比较,应用替格瑞洛PCI术后3个月内出血增多,大出血未见增加,替格瑞洛和氯吡格雷在老年NSTACS行PCI术的患者中12个月MACCE相似,替格瑞洛的呼吸困难发生率较高。Objective To compare the safety and efficacy of ticagrelor and clopidogrel in elderly patients with NSTEACS.Methods Five hundred and fifty-three NSTEACS patients aged>65 years were divided into clopidogrel treatment group(n=374)and ticagrelor treatment group(n=179).The patients were followed up for 12 months.The incidence of hemorrhage,MACCE and dyspnea was compared and analyzed.Results The incidence of hemorrhage and dyspnea was significantly higher in clopidogrel treatment group than in ticagrelor treatment group during the 12-month follow-up period after PCI(22.9%vs 9.4%,P=0.000;1.7%vs 0.0%,P=0.034).No significant difference was detected in the incidence of MACCE and massive hemorrhage between the two groups(P>0.05).Kaplan-Meier survival curve analysis showed that the incidence of massive hemorrhage was significantly higher in ticagrelor treatment group than in clopidogrel group at month 3 after double antiplatelet therapy(15.6%vs 2.4%,Plog-rank<0.01).No significant difference was detected in the incidence of massive hemorrhage between the two groups at months 3-12 after double antiplatelet therapy(Plog-rank>0.05).COX regression analysis showed that the risk of hemorrhage induced by ticagrelor was 6.277-fold and 1.726-fold higher respectively than that induced by clopidogrel at month 3(95%CI:2.668-14.767,P=0.000)and at months 3-12 of double antiplatelet therapy after adjustment of confounding factors(P>0.05).Conclusion The incidence of hemorrhage induced by ticagrelor is higher than that induced by clopidogrel with no massive hemorrhage increased at month 3 after PCI.The incidence of MACCE induced by clopidogrel and ticagrelor is similar in elderly NSTEACS patients at month 12 after PCI.The incidence of dyspnea induced by ticagrelor is higher than that induced by clopidogrel.

关 键 词：急性冠状动脉综合征 血小板聚集抑制剂 出血 呼吸困难 

分 类 号：R541.4[医药卫生—心血管疾病]