De Backer Ole, Ratcovich Hanna, Biasco Luigi, Pedersen Frants, Helqvist Steffen, Saunamäki Kari, Tilsted Hans-Henrik, Clemmensen Peter, Olivecrona Goran, Kelbaek Henning, Jørgensen Erik, Engstrøm Thomas, Holmvang Lene
Ole De Backer, MD, PhD, Kardiologisk klinik B 2012, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark, Tel.: +45 35457086, E-mail:
Thromb Haemost. 2015 Aug 31;114(3):623-31. doi: 10.1160/TH15-01-0026. Epub 2015 May 21.
The newer oral P2Y12 inhibitors prasugrel and ticagrelor have been reported to be more potent and faster-acting antiplatelet agents than clopidogrel. This study aimed to investigate whether prehospital loading with prasugrel or ticagrelor improves early coronary reperfusion as compared to prehospital loading with clopidogrel in a real-world ST-elevation myocardial infarction (STEMI) setting. Over a 70-month period, 3497 patients with on-going STEMI of less than 6 hours and without cardiac arrest or cardiogenic shock underwent primary percutaneous coronary intervention (PPCI) at our centre. The primary endpoint of this study was the proportion of patients who did not meet the criteria for TIMI (Thrombolysis In Myocardial Infarction) flow grade 3 in the infarct-related artery at initial angiography before PPCI. Prehospital loading with prasugrel (n = 883) or ticagrelor (n = 491) did not significantly improve coronary reperfusion as compared to prehospital loading with clopidogrel (n = 1,532) - a TIMI-flow 3 at initial angiography was absent in 71.7 %, 69.0 % and 71.5 % of patients, respectively. Major adverse cardiac event (MACE) rates were low at 30 days (3.4 % to 4.0 %) and did not significantly differ between the different P2Y12 inhibitor regimens. In conclusion, this large observational, non-randomised study is the first to show that prehospital loading with the newer P2Y12 inhibitors does not improve early coronary reperfusion as compared to prehospital loading with clopidogrel in a PPCI cohort excluding cardiac arrest and cardiogenic shock.
据报道，新型口服P2Y12抑制剂普拉格雷和替格瑞洛比氯吡格雷是更强效、起效更快的抗血小板药物。本研究旨在调查在真实世界的ST段抬高型心肌梗死（STEMI）患者中，与院前服用氯吡格雷相比，院前服用普拉格雷或替格瑞洛是否能改善早期冠脉再灌注。在70个月的时间里，3497例STEMI持续时间小于6小时、无心脏骤停或心源性休克的患者在我们中心接受了直接经皮冠状动脉介入治疗（PPCI）。本研究的主要终点是在PPCI前初次血管造影时梗死相关动脉未达到心肌梗死溶栓（TIMI）血流3级标准的患者比例。与院前服用氯吡格雷（n = 1532）相比，院前服用普拉格雷（n = 883）或替格瑞洛（n = 491）并未显著改善冠脉再灌注——初次血管造影时TIMI血流3级分别在71.7%、69.0%和71.5%的患者中未出现。30天时主要不良心脏事件（MACE）发生率较低（3.4%至4.0%），不同P2Y12抑制剂治疗方案之间无显著差异。总之，这项大型观察性、非随机研究首次表明，在排除心脏骤停和心源性休克的PPCI队列中，与院前服用氯吡格雷相比，院前服用新型P2Y12抑制剂并不能改善早期冠脉再灌注。
