替格瑞洛与氯吡格雷在接受经皮冠状动脉介入治疗的稳定型冠心病患者中的有效性和安全性比较  

Efficacy and Safety of Ticagrelor versus Clopidogrel in Patients with Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

作　　者：栗佳男 王勇[2] 邱洪[2] 郭婷婷 席子惟 师皓天 吴永健[2] 窦克非[2] 乔树宾[2] 杨跃进[2] 高润霖[2] LI Jianan;WANG Yong;QIU Hong;GUO Tingting;XI Ziwei;SHI Haotian;WU Yongjian;DOU Kefei;QIAO Shubin;YANG Yuejin;GAO Runlin(Department of Cardiology and Macrovascular Disease,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Cardiology,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Fuwai Yunnan Cardiovascular Hospital,Kunming 650102,China)

机构地区：[1]首都医科大学附属北京天坛医院心脏及大血管病中心,北京市100070 [2]国家心血管病中心中国医学科学院北京协和医学院阜外医院心内科,北京市100037 [3]云南省阜外心血管病医院心内科,昆明市650102

出　　处：《中国分子心脏病学杂志》2023年第3期5374-5379,共6页Molecular Cardiology of China

基　　金：云南省心血管病临床医学中心项目(FZX2019-06-01)。

摘　　要：目的 比较替格瑞洛与氯吡格雷在接受经皮冠状动脉介入治疗(PCI)的稳定型冠心病(SCAD)患者中的有效性和安全性。方法 选择2018年1—12月中国医学科学院阜外医院接受PCI治疗的SCAD患者4 894例进行回顾性分析。所有患者均接受双联抗血小板治疗(DAPT),出院时根据患者服用双联抗血小板药物的情况将患者分为替格瑞洛组(n=697)和氯吡格雷组(n=4 197)。分析两组患者的主要不良心脑血管事件(MACCE)和心肌梗死溶栓(TIMI)出血事件。结果 经过倾向性评分匹配后,替格瑞洛组患者MACCE的发生率显著低于氯吡格雷组患者[4.0%比6.7%,风险比(HR)=0.55,95%置信区间(95%CI):0.32~0.79,P=0.019]。且替格瑞洛组患者全因死亡的发生率显著低于氯吡格雷组患者(1.6%比3.3%,HR=0.49,95%CI:0.21~0.84,P=0.037)。而两组患者TIMI出血事件的发生率差异无统计学意义(4.9%比4.3%,HR=1.35,95%CI:0.84~1.72,P=0.609)。结论 在接受PCI治疗的SCAD患者中,与氯吡格雷组相比,替格瑞洛组患者MACCE的发生率较低,而TIMI出血风险无明显增加。Objective To compare the efficacy and safety of ticagrelor and clopidogrel in stable coronary artery disease(SCAD) patients undergoing percutaneous coronary intervention(PCI).Methods Totally 4 894 SCAD patients who underwent PCI from January 2018 to December 2018 were enrolled in this study.All patients received dual antiplatelet therapy(DAPT) and were divided into ticagrelor group(n=697) and clopidogrel group(n=4 197).The major adverse cardiovascular and cerebrovascular event(MACCE) and myocardial infarction thrombolysis(TIMI) bleeding events in the two groups of ticagrelor or clopidogrel were analyzed.Results After propensity score matching analysis,the incidence of MACCE in the ticagrelor group was significantly lower than that in the clopidogrel group [4.0% vs 6.7%,hazard ratio(HR)=0.55,95% confidence interval(CI):0.32-0.79,P=0.024].The incidence of all-cause deaths was lower in the ticagrelor group than in the clopidogrel group(1.6% vs 3.3%,HR=0.49,95%CI:0.21-0.84,P=0.037).The incidence of TIMI bleeding events was not significantly different between the ticagrelor group and the clopidogrel group (4.9%vs 4.3%,HR=1.35,95%CI:0.84-1.72,P=0.609).Conclusions Ticagrelor was associated with a lower incidence of MACCE and without an increased risk of TIMI bleeding events in patients with SCAD receiving PCI.

关 键 词：稳定性冠心病 替格瑞洛 氯吡格雷 经皮冠状动脉介入治疗 安全性 有效性 

分 类 号：R541.4[医药卫生—心血管疾病]