摘要
目的探讨双联抗血小板和三联抗血小板治疗对行经皮冠状动脉介入治疗(PCI)的糖尿病合并ST段抬高型心肌梗死(STEMI)患者的近期疗效和安全性。方法选择接受急诊PCI的糖尿病合并STEMI患者258例作为研究对象,随机分为阿司匹林+氯吡格雷(DAPT)组(A组)85例,阿司匹林+氯吡格雷+替罗非班(TAPT)组(B组)87例,阿司匹林+替格瑞洛+替罗非班(TAPT)组(C组)86例,比较三组患者的基本临床资料、冠状动脉病变特征、住院时间和并发症发生率。结果与A组比较,PCI后B组和C组患者TIMI 3级血流和TMPG 3级心肌灌注明显升高,住院时间短于A组,主要并发症的发生率及30 d的病死率显著降低,植入主动脉内球囊反搏(IABP)的例数显著减少(P均<0.05)。与B组对比,C组TMPG 3级心肌灌注显著增高,梗死后心绞痛、严重心律失常和KillipⅢ级以上心功能发生率显著降低(P均<0.05)。与A组比较,B组轻度出血,C组轻、中度出血的发生率显著增高(P<0.05);与B组比较,C组轻、中度出血的的发生率显著增高(P<0.05)。结论糖尿病合并STEMI患者急诊PCI时在双联抗血小板治疗基础上联合应用替罗非班能够有效的改善TIMI血流和TMPG心肌灌注,降低不良心血管事件的发生,替格瑞洛的作用优于氯吡格雷,但阿司匹林和替格瑞洛双联抗血小板的基础上联合应用替罗非班必须密切关注出血并发症。
Objective To investigate the efficacy and safety of dual and triple antiplatelet therapy(DAPT and TAPT)in emergency percutaneous coronary interventions(PCIs)performed in patients with diabetes and acute ST segment elevation myocardial infarctions(D-STEMI).Methods The D-STEMI patients(n=258)were randomly divided into three groups.Group A(85 patients)was treated with aspirin and clopidogrel;group B(87 patients)received aspirin,clopidogrel,and tirofiban;and group C(86 patients)was treated with aspirin,ticagrelor,and tirofiban.Patients in all three groups received oral DAPT,and the patients in groups B and C received intravenous tirofiban when emergency PCI was performed.The basic clinical data,coronary lesion characteristics,length of hospital stay,and complication rate were compared between the three groups.Results Compared with group A,the post-PCI thrombolysis in myocardial infarction(TIMI)grade 3 blood flow and the TIMI myocardial perfusion grade(TMPG)3 in groups B and C were significantly increased(P<0.05),and the incidence of major adverse cardiac events(MACE)was significantly decreased(P<0.05).Compared with group B,the rate of TMPG 3 in group C was significantly increased(P<0.05),and the incidence of MACE was significantly decreased(P<0.05).Patients in group B exhibited minor bleeding;however,the incidence of mild to moderate bleeding in group C was significantly increased(P<0.05).Conclusions TAPT effectively improved the TIMI blood flow and TMPG and reduced the occurrence of MACE.Ticagrelor was more effective than clopidogrel in TAPT;however,when using the combination of aspirin,ticagrelor,and tirofiban,close attention should be paid to possible bleeding complications.
作者
刘洋
刘恒亮
陈奇
姬劲锐
陈楠
贾凯龙
Liu Yang;Liu Hengliang;Chen Qi;Ji Jinrui;Chen nan;Jia Kailong(Department of Cardiology,Affiliated People's Hospital of Zhengzhou,Southern Medical University. Zhengzhou 450003 China)
出处
《中国循证心血管医学杂志》
2019年第2期200-204,208,共6页
Chinese Journal of Evidence-Based Cardiovascular Medicine
基金
郑州市创新型科技人才队伍建设项目(096SYJH331144)
关键词
急性心肌梗死
糖尿病
急诊经皮冠状动脉介入治疗
抗血小板
出血
Acute myocardial infarction
Diabetes
Emergency percutaneous coronary intervention
Antiplatelet
Bleeding
