Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA.
Am Heart J. 2010 Jul;160(1):202-7. doi: 10.1016/j.ahj.2010.04.018.
Pretreatment with clopidogrel reduces ischemic complications before percutaneous coronary intervention (PCI). Limited data exist regarding the effect of pretreatment for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI.
Prospective data were analyzed from a regional STEMI system using rapid transfer for primary PCI in 30 community hospitals. Zone 1 community hospitals are <60 miles and Zone 2 hospitals are 60 to 210 miles away from the PCI hospital. Compared with 63 minutes in the PCI hospital, median door-to-balloon times were 94 minutes in Zone 1 and 123 minutes in Zone 2 hospitals. All patients received aspirin, unfractionated heparin, and clopidogrel 600 mg in the emergency department of the presenting hospital within 15 minutes of diagnosis.
From April 2003 through December 2008, 2,014 consecutive STEMI patients were pretreated with clopidogrel before PCI, with a median (25th-75th percentile) duration from pretreatment to PCI of 75 (58-93) minutes. Patients with longer pretreatment duration had significantly reduced reinfarction/reischemia at 30 days (Zone 1: 0.85%, Zone 2: 0.9%) compared with nontransferred patients (3.2%, P = .001) as well as reduced stent thrombosis (Zone 1: 0.6%, Zone 2: 0.6% vs Abbott Northwestern: 2.0%; P = .04). Similarly, pretreatment duration of >60 minutes before PCI had reduced 30-day reinfarction/reischemia (1.0% vs 2.9%, P = .003). There were no significant differences in mortality or major bleeding.
ST-segment elevation myocardial infarction patients undergoing primary PCI in a regional STEMI network who received earlier pretreatment with a 600-mg loading dose of clopidogrel had less ischemic complications without increased bleeding or mortality.
氯吡格雷预处理可降低经皮冠状动脉介入治疗（PCI）前的缺血性并发症。关于接受直接 PCI 的 ST 段抬高型心肌梗死（STEMI）患者的预处理效果，目前仅有有限的数据。
对通过区域 STEMI 系统从 30 家社区医院快速转送至 PCI 医院行直接 PCI 的患者进行前瞻性数据分析。1 区社区医院距离 PCI 医院<60 英里，2 区医院距离 PCI 医院 60-210 英里。与 PCI 医院的 63 分钟相比，1 区和 2 区医院的门球时间中位数分别为 94 分钟和 123 分钟。所有患者在就诊医院的急诊科于诊断后 15 分钟内接受阿司匹林、未分级肝素和氯吡格雷 600mg。
2003 年 4 月至 2008 年 12 月，2014 例连续 STEMI 患者在 PCI 前接受氯吡格雷预处理，从预处理到 PCI 的中位（25-75 百分位数）时间为 75（58-93）分钟。预处理时间较长的患者 30 天内再梗死/再缺血发生率明显降低（1 区：0.85%，2 区：0.9%；与非转院患者相比：3.2%，P =.001），支架血栓形成发生率也降低（1 区：0.6%，2 区：0.6%；与 Abbott Northwestern 相比：2.0%；P =.04）。同样，PCI 前>60 分钟的预处理时间可降低 30 天再梗死/再缺血（1.0% vs 2.9%，P =.003）。死亡率或大出血无显著差异。
在区域 STEMI 网络中接受直接 PCI 的 STEMI 患者，更早接受氯吡格雷 600mg 负荷剂量预处理，可减少缺血性并发症，不增加出血或死亡率。
