论文部分内容阅读
目的评估在急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠脉介入治疗(PCI)患者应用新型P2Y12受体拮抗剂替格瑞洛的疗效与安全性。方法选取了2013年9月至2014年2月期间于沈阳军区总医院心内科住院并接受PCI治疗的STEMI患者,随访资料完整病例441例。依据PCI围术期抗血小板药物应用分为替格瑞洛组208例及氯吡格雷组233例。远期观察(1年)随访期间全因死亡、脑卒中、主要心血管不良事件(MACE)及出血事件的发生情况。结果两组基线资料比较,替格瑞洛组年龄偏大、收缩压低,且男性、吸烟、Grace评分≥109以及CYP2C19基因型为中慢代谢的患者所占比例高(P<0.05)。同时,替格瑞洛组联合应用替罗非班例数明显多于氯吡格雷组(P=0.000)。随访1年发现,替格瑞洛组靶血管再狭窄发生率明显低于氯吡格雷组[1.0%(2/208)对5.6%(13/233),P=0.008]。随访期间两组MACE及安全性终点事件发生率无显著差异(P>0.05)。Cox分析发现Grace<109分(HR4.99,95%CI 1.25~6.10)及中慢代谢CYP2C19基因型(HR 5.86,95%CI 2.54~13.48)的患者应用替格瑞洛后MACE事件发生率明显降低(P<0.05)。结论 STEMI患者行PCI治疗围术期应用替格瑞洛明显降低靶血管再狭窄发生率,同时未增加出血风险。对于中低危、中慢代谢CYP2C19基因型的患者疗效显著,替格瑞洛在STEMI患者行PCI治疗中安全有效。
Objective To evaluate the efficacy and safety of ticagrelor, a novel P2Y12 receptor antagonist, in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent emergency percutaneous coronary intervention (PCI). Methods A total of 441 patients with STEMI who were hospitalized and received PCI in Department of Cardiology, Shenyang Military Region General Hospital from September 2013 to February 2014 were selected. According to PCI perioperative antiplatelet drugs are divided into ticagrelor group 208 cases and clopidogrel group 233 cases. Long-term observation (1 year) All-cause death, stroke, major adverse cardiovascular events (MACE) and bleeding events during follow-up. Results Compared with baseline data, the patients in the ticagrelor group were older, had lower systolic pressure, and had a higher proportion of men with smoking, Grace score≥109 and CYP2C19 genotypes with moderate metabolic rate (P <0.05). In the meantime, there were significantly more tirofiban-treated patients in the ticagrelor group than in the clopidogrel group (P = 0.000). One year after follow-up, the incidence of target vascular restenosis in the ticagrelor group was significantly lower than that in the clopidogrel group (1.0% (2/208) vs 5.6% (13/233), P = 0.008]. There was no significant difference in the incidence of MACE and safety end point between the two groups during follow-up (P> 0.05). Cox analysis showed that the incidence of MACE was significantly higher in patients with Grace <109 (HR4.99, 95% CI 1.25-6.10) and moderately metabolized CYP2C19 genotype (HR 5.86, 95% CI 2.54-13.48) after ticagrelor Decreased (P <0.05). Conclusion Perioperative application of ticagrelor in STEMI patients undergoing PCI significantly reduces the incidence of target vascular restenosis without increasing the risk of hemorrhage. For moderate to low risk, moderate metabolism CYP2C19 genotype in patients with significant effect, ticagrelor in STEMI patients with PCI in the safe and effective.