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目的观察替格瑞洛在溶栓失败后补救性经皮冠状动脉介入治疗(PCI)患者中的疗效及安全性。方法入选2013~2014年因急性ST段抬高型心肌梗死(STEMI)的溶栓失败后12 h内于我院行补救PCI的患者246例。随机将符合条件的患者分为替格瑞洛组(n=121)和氯吡格雷组(n=125),替格瑞洛组术前给予替格瑞洛180 mg,术后90 mg bid联合阿司匹林100 mg qd;氯吡格雷组术前给予氯吡格雷300 mg,术后75 mg qd联合阿司匹林100 mg qd。采用TIMI血流分级(TFG)、校正的TIMI记帧(CTFC)和TIMI心肌灌注分级(TMPG)评价比较两组术后心肌灌注水平。随访12月比较两组患者的主要不良心脑血管事件(MACCE)的发生率和出血事件及其它不良事件的发生率。结果两组心肌灌注水平差异无统计学意义。替格瑞洛组与氯吡格雷组相比MACCE复合终点累计发生率降低,差异具有统计学意义(6.6%vs.15.2%HR=0.395,95%CI:0.166-0.940,P<0.05)。两组总体主要出血、主要致命/危及生命的出血事件发生率差异无统计学意义。结论替格瑞洛在溶栓失败后补救PCI患者中同样安全有效。
Objective To observe the efficacy and safety of ticagrelor in patients undergoing salvaged percutaneous coronary intervention (PCI) after failed thrombolysis. Methods A total of 246 patients undergoing PCI for PCI within 12 hours after thrombolysis in patients with acute ST-elevation myocardial infarction (STEMI) from 2013 to 2014 were enrolled. Eligible patients were randomly assigned to receive ticagrelor (n = 121) and clopidogrel (n = 125), to receive ticagrelor 180 mg preoperatively and to receive 90 mg bid postoperatively Aspirin 100 mg qd; clopidogrel group preoperatively given clopidogrel 300 mg, 75 mg qd postoperative aspirin 100 mg qd. TIMI flow classification (TFG), corrected TIMI frame (CTFC) and TIMI myocardial perfusion grading (TMPG) were used to evaluate the postoperative myocardial perfusion. The incidences of major adverse cardiovascular and cerebrovascular events (MACCE) and the incidence of bleeding and other adverse events were compared between the two groups in December. Results There was no significant difference in myocardial perfusion between the two groups. The cumulative incidence of MACCE composite endpoint was lower in the ticagrelor group and the clopidogrel group (6.6% vs.15.2% HR = 0.395, 95% CI: 0.166-0.940, P <0.05). There were no significant differences in the overall incidence of major bleeding and major fatal / life-threatening bleeding between the two groups. Conclusion Ticagrelor is also safe and effective in rehabilitating PCI patients after failed thrombolysis.