替格瑞洛和氯吡格雷在急性心肌梗死病人溶栓后PCI治疗中的疗效与安全性分析
摘要
目的比较替格瑞洛和氯吡格雷在急性心肌梗死病人溶栓后经皮冠状动脉介入治疗(PCI)中的疗效与安全性差异。方法选取2014年4月—2016年4月于十堰市太和医院就诊的280例急性心肌梗死病人,随机分为替格瑞洛组和氯吡格雷组,在溶栓后PCI的基础上分别给予替格瑞洛和氯吡格雷抗血小板凝集治疗,并进行为期12个月的随访,比较两组病人PCI术后TIMI血流分级、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、终点事件发生情况和药物相关不良反应。结果 PCI术后替格瑞洛组病人TIMI血流分级Ⅱ～Ⅲ级比例显著高于氯吡格雷组(99.29%与94.29%,P<0.05)。两组病人终点事件的发生风险比较差异无统计学意义[HR=1.851,95%CI(0.928,3.636),P=0.082];氯吡格雷组病人发生心血管相关死亡的风险明显高于替格瑞洛组[HR=2.664,95%CI(1.033,7.332),P=0.048]。两组病人的不良反应发生率比较差异无统计学意义(21.43%与16.43%,P>0.05)。结论与氯吡格雷相比,在急性心肌梗死病人溶栓后PCI治疗中应用替格瑞洛能够更好地恢复冠状动脉血流,改善心功能,降低心血管相关死亡风险。
引文
[1] LINDHOLM D,VARENHORST C,CANNON C P,et al.Ticagrelor vs.clopidogrel in patients with non-ST-elevation acute coronary syndrome with or without revascularization:results from the PLATO trial[J].Eur Heart J,2014,35(31):2083-2093.
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[3] WESTMAN P C,LIPINSKI M J,TORGUSON R,et al.A comparison of cangrelor,prasugrel,ticagrelor,and clopidogrel in patients undergoing percutaneous coronary intervention:a network meta-analysis[J].Cardiovasc Revasc Med,2017,18(2):79-85.
[4] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[5] 张勇,王燕妮.急性ST段抬高型心肌梗死患者治疗延误的影响因素分析[J].西安交通大学学报(医学版),2013,34(3):413-415.
[6] 庞军,张钲,白明,等.中国人群急诊PCI与先溶栓后择期行PCI治疗急性心肌梗死的疗效和安全性荟萃分析[J].临床心血管病杂志,2014,30(4):328-331.
[7] 郭小梅,彭稳中.STEMI患者溶栓后转诊PCI应注意的几个问题[J].临床心血管病杂志,2013,29(9):641-643.
[8] SU Q,LI L,NAING K A,et al.Safety and effectiveness of nitroprusside in preventing no-reflow during percutaneous coronary intervention:a systematic review[J].Cell Biochem Biophys,2014,68(1):201-206.
[9] ZHUNUSSOV Y,TAIZHANOVA D,ABDULLABEKOVA R,et al.Optimum application of modern antithrombotic drugs among patients with the acute coronary syndrome with the risk of stricture formation of coronary arteries[J].Georgian Med News,2016(251):40-45.
[10] 王海波,黄宜杰,吴强,等.替格瑞洛与氯吡格雷对急性ST段抬高型心肌梗死的临床疗效对比研究[J].中国循环杂志,2014,29(8):574-577.
[11] CUEVAS C,RYAN N,QUIROS A,et al.Determinants of percutaneous coronary intervention success in repeat chronic total occlusion procedures following an initial failed attempt[J].World J Cardiol,2017,9(4):355-362.
[12] SEREBRUANY V,CHEREPANOV V,DUKHANIN A.Significant excess of early deaths after prehospital ticagrelor:the ATLANTIC trial challenge[J].Thromb Haemost,2015,114(1):7-8.
[13] BONACA M P,BHATT D L,OUDE O T,et al.Long-term tolerability of ticagrelor for the secondary prevention of major adverse cardiovascular events:a secondary analysis of the PEGASUS-TIMI 54 Trial[J].JAMA Cardiol,2016,1(4):425-432.
[14] BONACA M P,BHATT D L,COHEN M,et al.Long-term use of ticagrelor in patients with prior myocardial infarction[J].N Engl J Med,2015,372(19):1791-1800.
[15] VAN DERWERF J,KUMAR M A.Diagnosis and management of coagulopathy-related intracerebral hemorrhage[J].Semin Neurol,2016,36(3):274-287.
[16] FANAROFF A C,RAO S V.Antiplatelet therapy in percutaneous coronary intervention[J].Interv Cardiol Clin,2016,5(2):221-237.
[17] R?BER L,KLINGENBERG R,HEG D,et al.Safety of prasugrel loading doses in patients pre-loaded with clopidogrel in the setting of primary percutaneous coronary intervention:results of a nonrandomized observational study[J].JACC Cardiovasc Interv,2015,8(8):1064-1074.
[18] 中国医师协会心血管内科医师分会血栓防治专业委员会,中华医学会心血管病学分会介入学组,中华心血管病杂志编辑委员会.替格瑞洛临床应用中国专家共识[J].中华心血管病杂志,2016,44(2):112-120.
[2] STEG P G,JAMES S,HARRINGTON R A,et al.Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention:a Platelet Inhibition and Patient Outcomes (PLATO) trial subgroup analysis[J].Circulation,2010,122(21):2131-2141.
[3] WESTMAN P C,LIPINSKI M J,TORGUSON R,et al.A comparison of cangrelor,prasugrel,ticagrelor,and clopidogrel in patients undergoing percutaneous coronary intervention:a network meta-analysis[J].Cardiovasc Revasc Med,2017,18(2):79-85.
[4] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[5] 张勇,王燕妮.急性ST段抬高型心肌梗死患者治疗延误的影响因素分析[J].西安交通大学学报(医学版),2013,34(3):413-415.
[6] 庞军,张钲,白明,等.中国人群急诊PCI与先溶栓后择期行PCI治疗急性心肌梗死的疗效和安全性荟萃分析[J].临床心血管病杂志,2014,30(4):328-331.
[7] 郭小梅,彭稳中.STEMI患者溶栓后转诊PCI应注意的几个问题[J].临床心血管病杂志,2013,29(9):641-643.
[8] SU Q,LI L,NAING K A,et al.Safety and effectiveness of nitroprusside in preventing no-reflow during percutaneous coronary intervention:a systematic review[J].Cell Biochem Biophys,2014,68(1):201-206.
[9] ZHUNUSSOV Y,TAIZHANOVA D,ABDULLABEKOVA R,et al.Optimum application of modern antithrombotic drugs among patients with the acute coronary syndrome with the risk of stricture formation of coronary arteries[J].Georgian Med News,2016(251):40-45.
[10] 王海波,黄宜杰,吴强,等.替格瑞洛与氯吡格雷对急性ST段抬高型心肌梗死的临床疗效对比研究[J].中国循环杂志,2014,29(8):574-577.
[11] CUEVAS C,RYAN N,QUIROS A,et al.Determinants of percutaneous coronary intervention success in repeat chronic total occlusion procedures following an initial failed attempt[J].World J Cardiol,2017,9(4):355-362.
[12] SEREBRUANY V,CHEREPANOV V,DUKHANIN A.Significant excess of early deaths after prehospital ticagrelor:the ATLANTIC trial challenge[J].Thromb Haemost,2015,114(1):7-8.
[13] BONACA M P,BHATT D L,OUDE O T,et al.Long-term tolerability of ticagrelor for the secondary prevention of major adverse cardiovascular events:a secondary analysis of the PEGASUS-TIMI 54 Trial[J].JAMA Cardiol,2016,1(4):425-432.
[14] BONACA M P,BHATT D L,COHEN M,et al.Long-term use of ticagrelor in patients with prior myocardial infarction[J].N Engl J Med,2015,372(19):1791-1800.
[15] VAN DERWERF J,KUMAR M A.Diagnosis and management of coagulopathy-related intracerebral hemorrhage[J].Semin Neurol,2016,36(3):274-287.
[16] FANAROFF A C,RAO S V.Antiplatelet therapy in percutaneous coronary intervention[J].Interv Cardiol Clin,2016,5(2):221-237.
[17] R?BER L,KLINGENBERG R,HEG D,et al.Safety of prasugrel loading doses in patients pre-loaded with clopidogrel in the setting of primary percutaneous coronary intervention:results of a nonrandomized observational study[J].JACC Cardiovasc Interv,2015,8(8):1064-1074.
[18] 中国医师协会心血管内科医师分会血栓防治专业委员会,中华医学会心血管病学分会介入学组,中华心血管病杂志编辑委员会.替格瑞洛临床应用中国专家共识[J].中华心血管病杂志,2016,44(2):112-120.