替格瑞洛对经皮冠状动脉介入治疗老年急性ST段抬高型心肌梗死患者的疗效及安全性

目的探讨替格瑞洛对老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)的疗效及安全性。方法回顾性分析208例STEMI老年患者,根据用药不同分为替格瑞洛组103例和氯吡格雷组105例。两组患者均接受PCI治疗,术前均口服阿司匹林300 mg,继以100 mg/d,此外,替格瑞洛组口服替格瑞洛180 mg,继以每次90 mg,2次/d,氯吡格雷组口服氯吡格雷600 mg,继以75 mg/d,两组患者均治疗12个月。比较两组患者PCI术后冠状动脉血流情况,血小板聚集率,左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD),出血事件以及主要心血管不良事件(MACE)。结果替格瑞洛组患者PCI术后心肌梗死的溶栓治疗(TIMI)分级优于氯吡格雷组患者(Z=2.58,P=0.010),无复流或慢血流发生率低于氯吡格雷组患者的6.8%(7/103)与19.1%(20/105),χ^2=6.91,P=0.009。重复资料方差分析结果显示,两组患者血小板聚集率均随时间降低(F时间=87.54,P<0.001)。替格瑞洛组患者血小板聚集率下降幅度高于氯吡格雷组(F时间×组间=6.16,P<0.001)。替格瑞洛组患者血小板聚集率整体水平低于氯吡格雷组患者(F组间=17.84,P<0.001)。各时间点组间比较,替格瑞洛组患者血小板聚集率在术后1 h、1 d和3 d低于氯吡格雷组(t分别为14.39,13.19,6.53,P均<0.001)。两组患者PCI术后LVEF均升高(t分别为7.46,4.33,P均<0.001),组间比较,替格瑞洛组患者LVEF高于氯吡格雷组(t=4.28,P<0.001);两组患者PCI术后LVEDD均下降(t=9.36,6.47,P均<0.001),组间比较,替格瑞洛组患者LVEF低于氯吡格雷组(t=4.38,P<0.001)。两组患者出血和MACE发生率差异无统计学意义(χ^2=0.91,2.32,均P>0.05)。结论替格瑞洛在PCI术治疗老年STEMI中,抗血小板聚集效果好,能够降低无复流或慢血流发生率,改善患者心功能。

Investigation of efficacy and safety of Ticagrelor as add-on to a common therapy of aspirin in elderly patients with acute ST-segment elevation myocardial infarction and undergoing percufaneous coronary infervention

Objective To investigation of efficacy and safety of Ticagrelor vs.Clopidogrel as add-on to a common therapy of Aspirin in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)and undergoing percutaneous coronary intervention(PCI).Methods A total of 208 elderly patients with STEMI and receiving PCI were divided into the Ticagrelor group(n=103,receiving Ticagrelor 180 mg,followed by 90 mg twice a day)and the Clopidogrel group(n=105,receiving Clopidogrel 600 mg,followed by 75 mg/d)as add-on to a common therapy of Aspirin(300 mg before operation,followed by 100 mg/d).Both groups were treated for 12 months.Coronary artery blood flow,platelet aggregation rate,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),bleeding events and major adverse cardiovascular events(MACE)after PCI were compared between the two groups.Results The TIMI(thrombolysis in myocardial infarction)grading after PCI was better in the Ticagrelor group than in the Clopidogrel group(Z=2.58,P=0.010).The incidence of no-reflow or slow blood flow was lower in the Ticagrelor group than in the Clopidogrel group(6.8%or 7/103 vs.19.1%or 20/105,χ^2=6.91,P=0.009).The variance analysis of repeated data showed that the platelet aggregation rate was decreased along with time in both groups(Ftime=87.54,P<0.001).The decrement of platelet aggregation rate was higher in the Ticagrelor group than in the Clopidogrel group(Ftime×group=6.16,P<0.001).The overall level of platelet aggregation was lower in the Ticagrelor group than in the Clopidogrel group(Fgroup=17.84,P<0.001).The platelet aggregation rates at 1 hour,1 day and 3 days after operation were lower in the Ticagrelor group than in the Clopidogrel group(t=14.39,13.19 and 6.53,respectively,P<0.001).LVEF was increased in both groups after PCI(t=7.46 and 4.33,all P<0.001),while LVEF was higher in the ticagrelor group than in the clopidogrel group(t=4.28,P<0.001).LVEDD was decreased in both groups after PCI(t=9.36 and 6.47,all P<0.001),while LVEDD was lower in the ticagrelor group than in the clopidogrel group(t=4.38,P<0.001).There were no significant differences in the incidences of hemorrhage and MACE between the two groups(χ^2=0.91 and 2.32,all P>0.05).Conclusions Ticagrelor has good anti-platelet aggregation effect in the treatment of STEMI after PCI in the elderly,and it reduces the incidences of no-or slow reflow,improves cardiac function.