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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2017年第6期

页码:

667-671

栏目:

临床研究

出版日期:

2017-06-01

文章信息/Info

Title:

Efficacy of ticagrelor and clopidogrel in patients with acute coronary syndrome after elective percutaneous coronary intervention

作者:

李 超¹; 2; 李 毅¹; 李 晶¹; 王贺阳¹; 许晓明¹; 2; 陶 凌²; 韩雅玲¹

(1.沈阳军区总医院心血管内科，辽宁 沈阳 110016;
2.第四军医大学西京医院心血管内科，陕西 西安 710032)

Author(s):

LI Chao¹; 2;  LI Yi¹;  LI Jing¹;  WANG He-yang¹;  XU Xiao-ming¹; 2;  TAO Ling¹²;  HAN Ya-Ling¹

(1.Department of Cardiology, General Hospital, Shenyang Military Area Command, Shenyang 110016, Liaoning, China;
2.Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China)

关键词:

替格瑞洛; 氯吡格雷; 急性冠脉综合征; 经皮冠状动脉介入治疗

Keywords:

ticagrelor;  clopidogrel;  acute coronary syndrome;  percutaneous coronary intervention

分类号:

R514.4

DOI:

-

文献标识码:

A

摘要:

目的 分析替格瑞洛和氯吡格雷对急性冠脉综合征（ACS）患者择期经皮冠状动脉介入（PCI）治疗的有效性及安全性。方法 诊断为ACS并择期行PCI术的患者1 159例随访1年，依患者服用双重抗血小板药物不同分为替格瑞洛组(n=312)和氯吡格雷组(n=847)，其中3例在随访过程中排除，27例失访，最终纳入1 129例，替格瑞洛组(n=303)和氯吡格雷组(n=826)。比较两组患者基线资料的差异及主要心血管不良事件（MACE，包含心血管死亡、心肌梗死、缺血性卒中）和大出血事件（美国出血学术研究会制定的出血分级标准中Ⅱ型、Ⅲ型及Ⅴ型出血）的发生率。结果 替格瑞洛组患者肌钙蛋白I（TnI）偏高，左室射血分数（LVEF）值偏低，植入支架数多，最大狭窄率高，复杂病变比例高，桡动脉入路少，分次PCI比例高（均P<0.05）。替格瑞洛组发生MACE事件（15.2%）与氯吡格雷组（12.6%）相比〔危险比(hazard ratio,HR)=1.226，95%可信区间0.867~1.735，P=0.249〕及大出血事件替格瑞洛组（0.7%）与氯吡格雷组（0.7%）相比（HR=1.093，95%可信区间0.212~5.634，P=1），差异均无统计学意义。单因素分析影响预后的因素包括：男性、城市来源、LVEF、分次PCI是保护性因素；高脂血症、脑梗病史、病变血管数目、安放支架数目、最大狭窄率、醛固酮受体拮抗剂是危险性因素，利用可能影响患者预后的因素作为因子多元逐步Cox比例风险回归模型模型分析结果是替格瑞洛与氯吡格雷HR=1.118，95%可信区间0.755~1.656，P>0.05。结论 替格瑞洛和氯吡格雷用于ACS择期PCI术后患者的疗效和安全性相当。

Abstract:

AIM To investigate the differences in clinical application of tigrelor and clopidogrel and to explore the efficacy and safety of ticagrelor and clopidogrel in acute coronary syndrome (ACS) patients undergoing elective percutaneous coronary intervention (PCI). METHODS 2 276 cardiovascular patients in Xijing Hospital were selected from which 1159 were diagnosed as ACS and undergoing PCI. The patients were divided into ticagrelor group and clopidogrel group. Baseline data, major adverse cardiovascular events (MACE, including cardiovascular death, myocardial infarction, ischemic stroke) and major bleeding events (TypeⅡ, TypeⅢ and TypeⅤ set by Bleeding Academic Research Consortium) were compared between the two groups. RESULTS Higher TNI, lower EF value, more stent numbers, maximal stenosis rate, more multiple complex lesions, fewer transradial approach, and more multiple PCI were observed in ticagrelor group (P<0.05). Between the two groups, there was no statistically significant difference in MACE events (15.18% vs. 12.59%, HR=1.226, 95% confidence interval 0.867-1.735, P=0.249) and in serious bleeding events (0.66%: 0.73%, HR=1.093, 95% confidence interval 0.212-5.634, P=1). CONCLUSION Clinicians commonly to use ticagrelor for severe ACS cases even though clinically there is no significant difference in the efficacy and safety of ticagrelor and clopidogrel for post-PCI ACS patients.

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备注/Memo

备注/Memo:

收稿日期：2016-12-20.
通讯作者：韩雅玲，教授，主要从事冠心病的诊断与治疗研究 Email：hanyaling@263.net
共同通讯作者：陶凌，教授，主要从事糖尿病心肌损伤研究 Email：lingtao@fmmu.edu.cn
作者简介：李超，主治医师，硕士 Email：lichao19811228@sina.com

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更新日期/Last Update: 2017-06-06