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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
郭金成*,朱芙丽,蔡宜婷,陈文明,柳子静,郝明辉.替格瑞洛用于老年急性ST段抬高型心肌梗死急诊PCI治疗患者的临床研究[J].中华老年多器官疾病杂志,2016,15(10):734~738
替格瑞洛用于老年急性ST段抬高型心肌梗死急诊PCI治疗患者的临床研究
Clinical study of ticagrelor in ST segment elevation myocardial infarction elderly patients undergoing primary percutaneous coronary intervention
投稿时间:2016-06-07  修订日期:2016-06-30
DOI:10.11915/j.issn.1671-5403.2016.10.175
中文关键词:  老年人;替格瑞洛;急性心肌梗死;经皮冠状动脉介入治疗
英文关键词:aged; ticagrelor; acute myocardial infarction; percutaneous coronary intervention
基金项目:通州区卫生发展专项编号(twkyzx2014-05)
作者单位E-mail
郭金成*,朱芙丽,蔡宜婷,陈文明,柳子静,郝明辉 首都医科大学附属北京潞河医院心血管内科,北京 101149 guojcmd@126.com 
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中文摘要:
      目的 评估替格瑞洛用于急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)患者的临床疗效。方法 回顾性分析2012年11月至2014年12月北京潞河医院心血管内科急性STEMI接受急诊PCI手术患者240例,分成替格瑞洛(n=94)和氯吡格雷(n=146)两组,比较两组患者急诊PCI术后心肌梗死溶栓治疗(TIMI)3级血流、术后心电图ST段回落(STR)情况、出血学术研究联合会(BARC)定义的出血发生率、呼吸困难发生率、服药情况及停换药原因、院内和术后12个月主要心脏不良事件(MACE)发生率等指标。结果 与氯吡格雷组相比,替格瑞洛能提高PCI术后TIMI 3级血流的患者比例(90.5% vs 80.8%,P=0.024)。12个月内两组BARC出血分级、呼吸困难发生率差异无统计学意义(287% vs 240%,P=0412;128% vs 68%,P=0.121)。替格瑞洛组和氯吡格雷组12个月内停药或更改抗栓方案差异有统计学意义(P<0001),主要原因是医师更改抗栓方案、经济原因和呼吸困难(500% vs 14%,P<0001;128% vs 14%,P<0001;53% vs 07%,P=0025)。两组院内、12个月MACE差异无统计学意义(53% vs 55%,P=0957;85% vs 89%,P=0916)。结论 替格瑞洛用于老年STEMI患者急诊PCI可改善术后血流,且不增加出血发生率,停换药的原因是医师更改抗栓方案、经济原因和呼吸困难。
英文摘要:
      Objective To evaluate the effect and safety of ticagrelor in the elderly patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods Two hundred and forty consecutive elderly STEMI patients undergoing primary PCI in our hospital from November 2012 to December 2014 were recruited in this study, and divided into ticagrelor group (n=94) and clopidogrel group (n=146). Thrombolysis in myocardial infarction (TIMI) grade 3 flow, post-operative ST segment resolution (STR), bleeding incidence by Bleeding Academic Research Consortium (BARC) scale, dyspnea incidence, medication and causes for withdrawal and discontinuation of drugs, intra-hospital and 12-month occurrence of major adverse cardiac events (MACE) were observed and compared between the 2 groups. Results The percentage of TIMI grade 3 flow was significantly higher in the ticagrelor group than in the clopidogrel group (90.5% vs 80.8%, P=0.024). But there were no significant differences in the incidences of BARC types and dyspnea between the 2 groups (28.7% vs 24.0%, P=0.412; 12.8% vs 6.8%, P=0.121). Compared with the clopidogrel group, there were more patients with drug withdrawal or discontinuation of antiplatelet therapy in the ticagrelor group in the 12 months’ follow-up (P<0.001). The withdrawals of ticagrelor or clopidogrel mainly attributed to doctor’s preference, cost and severe dyspnea (500% vs 14%, P<0001; 128% vs 14%, P<0.001; 5.3% vs 0.7%, P=0.025). No significant difference was found in the incidence of MACE between the 2 groups during hospital staying and 12 months’ follow-up (5.3% vs 5.5%, P=0.957; 8.5% vs 8.9%, P=0.916). Conclusion Ticagrelor significantly improves blood flow in the elderly patients with STEMI after primary PCI and has no effect on the incidence of BARC bleeding. The reasons for withdrawal and discontinuation of ticagrelor are doctor’s preference, cost and dyspnea.
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