STEMI患者急诊PCI应用替格瑞洛与氯吡格雷的临床疗效对比

摘要

Objective To compare effects of ticagrelor and clopidogrel in percutaneous coronary intervention (PCI) of acute ST-segment elevation myocardial infarction (STEMI) patients. Methods From January 2014 to January 2016, 87 patients received emergency PCI were enrolled, including ticagrelor group (n=43) and clopidogrel group (n=44). TIMI blood flow before and after PCI was compared. The platelet inhibition rate was measured at 24 h and 1 month after operation. The incidence of major adverse cardiovascular events (MACE) and bleeding events was recorded within 12 months. Results TIMI blood flow was significantly improved in both groups after PCI. In ticagrelor group, 83.72% were TIMI grade 3, 11.63% were TIMI grade 2, 4.65% were TIMI grade 1. In clopidogrel group, 63.64% were TIMI grade 3, 25% were TIMI grade 2, 11.36% were TIMI grade 1. The platelet inhibition rate in ticagrelor group was (84.2±11.4)% at 24 h after operation and (75.8±9.7)% at 1 month postoperatively, which was higher than that in clopidogrel group (69.1±12.7)% (62.5±8.6)%, the difference was statistically significant (P<0.05). The incidence of severe heart failure in the ticagrelor group was lower than that in the clopidogrel group, the difference was statistically significant (P<0.05). There was no significant difference in the incidence of other MACE and bleeding events. Conclusion In patients with STEMI before and after the emergency PCI, ticagrelor has better platelet inhibition than clopidogrel, has better postoperative blood perfusion effect, and was safer.%目的 对比急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)使用替格瑞洛和氯吡格雷的效果差异.方法 选取2014年1月~2016年1月于宜昌市第二人民医院急诊科拟实施急诊PCI的STEMI患者87例,其中男性54例,女性33例.根据入院顺序随机分为替格瑞洛组(43例)和氯吡格雷组(44例).PCI术前和术后替格瑞洛组应用替格瑞洛,氯吡格雷组应用氯吡格雷.对比两组PCI术前、术后即刻的TIMI 血流;采用血栓弹力图检测两组术后24 h、1个月的血小板抑制率.记录两组药物治疗12个月内主要不良心血管事件(MACE)及出血事件的发生率.结果 与术前比较,两组患者术后TIMI血流均明显改善.PCI术后,替格瑞洛组TIMI 3级83.72%、TIMI 2级11.63%、TIMI 1级4.65%,氯吡格雷组TIMI 3级63.64%、TIMI 2级25.00%、TIMI 1级11.36%.替格瑞洛组的血小板抑制率术后24 h为(84.2±11.4)%、术后1个月为(75.8±9.7)%,均高于氯吡格雷组的(69.1±12.7)%和(62.5± 8.6)%,差异有统计学意义(P均<0.05).替格瑞洛组严重心衰发生率低于氯吡格雷组,差异有统计学意义(P<0.05),其他MACE及出血事件发生率无明显差异.结论 STEMI患者急诊PCI前后应用替格瑞洛较氯吡格雷具有更好的血小板抑制效果,术后血流灌注效果更好且安全性高.