中国全科医学2018，Vol.21Issue(12)：1428-1431,1436,5.DOI:10.3969/j.issn.1007-9572.2018.00.059
不同程度冠状动脉病变ST段抬高型急性心肌梗死患者抗栓效果比较研究
Comparison of Clinical Efficacy and Safety of Ticagrelor-based and Clopidogrel-based Antiplatelet Therapy in STEMI Patients with Different Degrees of Coronary Artery Disease
曾春艳 1纪征 2孙淑贤 2马威 2王兆翔 2贾风顺2
作者信息
- 1. 063000 河北省唐山市,华北理工大学
- 2. 063000 河北省唐山市,唐山工人医院心内一科
- 折叠
摘要
Abstract
Objective To observe and compare the clinical efficacy and safety of ticagrelor and clopidogrel in the treatment of ST-segment elevation myocardial infarction(STEMI).Methods We included 512 patients who were diagnosed with STEMI and underwent emergency coronary angiography in the First Department of Cardiology,Tangshan Gongren Hospital from January 2013 to July 2015.All of the patients received dual-antiplatelet therapy for >12 months.Follow-up lasted 12 months. The study group consisted of 252 patients who were diagnosed with STEMI and received treatment with ticagrelor combined with aspirin between May 2014 and July 2015.The control group consisted of 260 patients who were diagnosed with STEMI and received treatment with clopidogrel combined with aspirin between January 2013 and April 2014.The patients were ranked according to Gensini score.With the median score as a cut-off point,the patients were further divided into a study high-score subgroup(n=126), study low-score subgroup(n=126),control high-score subgroup(n=130) and control low-score subgroup(n=130). During 12-months follow up,major adverse cardiovascular events(MACE),bleeding events and heart failure were recorded. MACE included cardiogenic death,myocardial infarction,stroke,target vessel revascularization,stent thrombosis and recurrent angina.Bleeding events included mild,minor and major bleeding.Results The overall incidence of MACE in the study high-score subgroup(37.3%,47 cases) was significantly lower that in the control high-score subgroup(60.8%,79 cases)(χ2=14.099,P<0.001).The overall incidence of bleeding in the study high-score subgroup(32.5%,41 cases) was higher than that in the control high-score subgroup(20.0%,26 cases)(χ2=5.207,P<0.05),and the incidence of mild bleeding in the study high-score subgroup was higher than that in the control high-score subgroup(P<0.05).The incidence of heart failure in the study high-score subgroup was also significantly lower than that in the control high-score subgroup(15.9%vs.27.7%,P<0.05).There were no significant differences between the study low-score subgroup and control low-score subgroup in the overall incidence of MACE,overall incidence of bleeding and incidence of heart failure(P>0.05).Conclusion Ticagrelor combined with aspirin is more effective in reducing MACE and heart failure than clopidogrel combined with aspirin in STEMI patients with severe coronary artery disease,with only a slight increase in the risk of mild bleeding.In STEMI patients with less severe coronary artery disease,the two antiplatelet drugs have comparable efficacy and safety.关键词
心肌梗死/替格瑞洛/氯吡格雷/疗效比较研究/药物不良反应Key words
Myocardial infarction/Ticagrelor/Clopidogrel/Comparative effectiveness research/Adverse drug reaction分类
医药卫生引用本文复制引用
曾春艳,纪征,孙淑贤,马威,王兆翔,贾风顺..不同程度冠状动脉病变ST段抬高型急性心肌梗死患者抗栓效果比较研究[J].中国全科医学,2018,21(12):1428-1431,1436,5.
