Radojković Danijela Dordević, Perisić Zoran, Tomasević Miloje, Pavlović Milan, Apostolović Svetlana, Janković Ruzica, Damjanović Miodrag, Martinović Sonja Salinger, Bozinović Nenad, Milenković Dusan
Klinicki centar, Klinika za kardiologiju, 18 000 Nis, Srbija.
Vojnosanit Pregl. 2007 Feb;64(2):117-21. doi: 10.2298/vsp0702117d.
BACKGROUND/AIM: Most patients with acute myocardial infarction with ST-segment elevation (STEMI) are still treated with pharmacological reperfusion, which is not always successful. That is the reason for searching possibilities for a better success of reperfusion with adding new antiplatelet drugs. The aim of this study was to investigate weather addition of clopidogrel as a second antiplatelet drug, improves the patency of the infarct-related artery after STEMI.
We prospectively enrolled 65 patients, 29-72 years old, hospitalized due to the first STEMI within 6 hours after the on-set of a chest pain. They were treated with a fibrinolytic agent (streptokinase or tissue plasminogen activator--tPA), aspirin, and low molecular heparin (enoxaparin). A group of 50 patients, beside this therapy, received clopidogrel. Coronary angiography was performed between 5th and 10th day of hospitalization to assess for late patency of the infarct-related artery. Infarct-related artery was considered as patent if thrombolysis in myocardial infarction (TIMI) flow grade was 2 or 3, and as occluded if TIMI flow grade was 0 or 1.
In the group of patients who received double antiplatelet therapy (aspirin and clopidogrel), infarct-related artery was occluded in 3 cases (6%); in the group of patients without clopidogrel, infarct-related artery was occluded in 4 patients (26.7%),p < 0.05. There were less frequency of postinfarction angina (6% vs 13.3%), and rarer necessity for rescue percutaneous coronary intervention (4% vs. 13.3%) in the first group, but without statistical significance.
Adding of clopidogrel to the standard reperfusion pharmacotherapy, as a second antiplatelet drug, increases the number of patients with patent infarct-related artery and the success of reperfusion.
背景/目的：大多数ST段抬高型急性心肌梗死（STEMI）患者仍采用药物再灌注治疗，但并非总能成功。这就是寻求通过添加新的抗血小板药物来提高再灌注成功率的原因。本研究的目的是调查添加氯吡格雷作为第二种抗血小板药物是否能改善STEMI后梗死相关动脉的通畅情况。
我们前瞻性纳入了65例年龄在29至72岁之间、因胸痛发作6小时内首次发生STEMI而住院的患者。他们接受了纤维蛋白溶解剂（链激酶或组织型纤溶酶原激活剂-tPA）、阿司匹林和低分子肝素（依诺肝素）治疗。其中50例患者在此治疗基础上还接受了氯吡格雷治疗。在住院第5天至第10天进行冠状动脉造影，以评估梗死相关动脉的晚期通畅情况。如果心肌梗死溶栓（TIMI）血流分级为2或3，则梗死相关动脉被认为通畅；如果TIMI血流分级为0或1，则梗死相关动脉被认为闭塞。
在接受双重抗血小板治疗（阿司匹林和氯吡格雷）的患者组中，有3例（6%）梗死相关动脉闭塞；在未接受氯吡格雷治疗的患者组中，有4例（26.7%）梗死相关动脉闭塞，p<0.05。第一组梗死后心绞痛的发生率较低（6%对13.3%），抢救性经皮冠状动脉介入治疗的必要性也较低（4%对13.3%），但无统计学意义。
在标准再灌注药物治疗中添加氯吡格雷作为第二种抗血小板药物，可增加梗死相关动脉通畅的患者数量并提高再灌注成功率。
