替格瑞洛在急性冠脉综合征患者经皮冠状动脉介入治疗术后的应用价值

目的:评价替格瑞洛在急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后的应用价值。方法:将我院收治的565例成功行PCI的急性冠脉综合征(acute coronary syndrome,ACS)患者随机分为2组:氯吡格雷组253例,术后口服氯吡格雷75 mg、QD;替格瑞洛组312例,术后口服替格瑞洛首剂180 mg,维持量90mg、BID。两组患者术后常规口服阿司匹林100 mg、QD。研究主要终点为主要不良心血管事件(major adverse cardiovascular events,MACE),包括全因死亡、靶血管血运重建和脑梗塞;次要终点为TIMI主要出血(定义为血红蛋白下降50 g/L或颅内出血有关的临床显著出血事件)。结果:565例患者平均随访12个月,替格瑞洛组MACE发生率低于氯吡格雷组(3.8%vs.8.7%,P0.05),两组TIMI主要出血事件发生率比较,差异无统计学意义(2.9%vs.3.2%,P0.05)。结论:替格瑞洛能明显减少PCI术后主要不良心血管事件,并不增加主要出血。

Clinical Value of Ticagrelor in Patients with Acute Coronary Syndrome treated by Percutaneous Coronary Intervention*

Objective:To evaluate the clinical value of ticagrelor in patients with acute coronary syndrome (ACS) treated by percutaneous coronary intervention (PCI).Methods:A total of 565 cases of ACS patients successfully treated by PCI were randomly divided into 2 groups. Clopidogrel group (n=253) received clopidogrel 75 mg daily. Ticagrelor group received ticagrelor 180 mg loading dose and 90 mg twice daily thereafter. Both groups received asprin 100 mg daily conventionally. The primary end points were defined as major adverse cardiovascular events (MACE), namely a composite of death from any cause, target vessel revascularization (TVR), or ischemic stroke. Secondary end points were major bleeding events classified by TIMI.Results:All the 565 patients were followed for an average of 12 months and the clinical outcomes were analyzed at 12 months after PCI. The morbidity rates of MACE in Ticagrelor group was lower than that of the Clopidogrel group at 12 months (3.8%vs. 8.7%, P<0.05). No significant difference was found in the rates of major bleeding between the two groups (2.9%vs. 3.2%, P>0.05).Conclusion:Ticagrelor therapy significantly reduced the rate of MACE without an increase of major bleeding after PCI.