摘要
目的:探讨替格瑞洛与冠状动脉介入(PCI)术后急性冠状动脉综合征(ACS)患者发生心律失常不良事件的相关性。方法:选择PCI择术期625例急性非ST段抬高性心肌梗死患者作为研究对象,随机分为替格瑞洛组(n=311)和氯吡格雷组(n=314)。在PCI术后给予阿司匹林的基础上,替格瑞洛组给予替格瑞洛治疗,氯吡格雷组给予氯吡格雷治疗。随访12个月,分别在PCI术后1个月、6个月和12个月时,对两组患者进行24 h十二导联动态心电图监测并分析两组患者的心律失常不良事件。结果:两组PCI术后心律失常不良事件的总发生率相似(P>0.05);术后12个月,替格瑞洛组的平均心率明显低于氯吡格雷组(P=0.044),且心率降低(P=0.027)和缓慢性心律失常患者例数均明显多于氯吡格雷组(P=0.034)。PCI术后6个月和12个月,替格瑞洛组窦性停搏的发生率明显高于氯吡格雷组(P<0.05);替格瑞洛组中多次停搏的发生率明显高于停搏1次的发生率(P<0.01)。结论:PCI术后替格瑞洛所致的心动过缓、停搏等心律失常不良事件的发生率明显高于氯吡格雷,必要时可给予抗心律失常药物。
Objective： To investigate the relationship between ticagrelor treatment and the adverse events （AE） of arrhythmia after percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）. Methods： Totally 625 patients with acute non-ST segment elevation myocardial infarction in operation time of percutaneous coronary intervention were selected as the subjects. The patients were randomly divided into ticagrelor group （n = 311 ） and clopidogrel group （n = 314）. On the basis of aspirin treatment after PCI, the patients in ticagrelor group were treated with ticagrelor, and those in clopidogrel group received clopidogrel. The two groups were monitored by twelve lead Holter for 24 h at 1, 6 and 12 months after PCI. AEs of arrhythmia were diagnosed and identified. Results ： The incidences of AEs were similar in the two groups （P 〉 0.05 ） at 1, 6, and 12 months after PCI. At 12 months after PCI, the average heart rate of ticagrelor group was significantly lower than that of clopidogrel group （P = 0. 044）. The number of patients with heart rate reduction （P = 0. 027） and chronic arrhythmia of ticagrelor group was significantly higher than that of clopidogrel group （P = 0. 034）. At 6 and 12 months after PCI, the incidence of sinus arrest in ticagrelor group was significantly higher than that in clopidogrel group （P 〈 0.05）. The incidence of multiple arrest was significantly higher than single arrest in ticagrelor group （P 〈 0. 01 ）. And the incidence of multiple arrest in ticagrelor group was significantly higher than that of clopidogrel group （P 〈 0.05）. Conclusion： The incidence of asymptomatic arrhymia such as bradycardia and cardiac arrest caused by ticagrelor after PCI is significantly higher than that caused by clopidogrel, and antiarrhythmic drugs may be given if necessary.
作者
刘鹏
周晓芳
钟萍
盛勇
孙学春
LIU Peng, ZHOU Xiao-fang, ZHONG Ping, CHENG Yong, SUN Xue-chun(Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People＇s Hospital Department of Cardiovascular Medicine, Chengdu 610072, Chin)
出处
《中国新药杂志》
CAS
CSCD
北大核心
2018年第6期668-671,共4页
Chinese Journal of New Drugs
