Di Vito Luca, Versaci Francesco, Limbruno Ugo, Pawlowski Tomasz, Gatto Laura, Romagnoli Enrico, Cattabiani Maria Alberta, Micari Antonio, Trivisonno Antonio, Marco Valeria, Prati Francesco
aSan Giovanni - Addolorata Hospital, Interventional Cardiology Unit bC.L.I. Foudation, Rome cOspedale A.Cardarelli, Campobasso dMisericordia Hospital, Grosseto, Italy eCentral Clinical Hospital of the Ministry of Interior, Warsaw, Poland. fDivision of Cardiology, Parma Hospital, Parma g Ettore Sansavini Health Science Foundation, Cotignola, Italy.
J Cardiovasc Med (Hagerstown). 2016 Sep;17(9):701-6. doi: 10.2459/JCM.0000000000000392.
We sought to assess the impact of different oral P2Y12 receptor inhibitors on residual thrombus and reperfusion indexes in ST-segment elevation myocardial infarction patients enrolled in the COCTAIL II trial, which included 128 primary percutaneous coronary interventions randomized to intracoronary vs. intralesion abciximab bolus with or without thrombectomy.
Patients were divided into three groups: clopidogrel (n = 44), prasugrel (n = 45) and ticagrelor (n = 39). Residual intra-stent thrombus was quantified by optical coherence tomography using both the number of cross-sections with thrombus area more than 10% and thrombus volume. Reperfusion indexes included thrombolysis in myocardial infarction (TIMI) flow, corrected TIMI frame count, myocardial blush grade (MBG) and complete ST-segment resolution (≥70%).
In the prasugrel group, optical coherence tomography depicted a lower percentage of cross-sections with residual thrombus area more than 10% [4.0 (1.0-8.5)], as compared with clopidogrel [8.0 (1.0-15.0), P = 0.011] and ticagrelor [7.0 (3.0-13.5), P = 0.026].A higher thrombus volume was found in the clopidogrel group 4.0 mm(2.7-6.2) as compared with the prasugrel group [2.8 mm(1.8-4.4), P = 0.023], whereas the other between-group comparisons yield no significant differences. The frequency of MBG 3 was higher in the prasugrel group (73.3%) as compared with clopidogrel (45.5%) and ticagrelor [(56.4%), P = 0.027]. Final TIMI flow, TIMI frame count and ST resolution were not significantly different across the three groups (P = 0.423, 0.179 and 0.848, respectively). At multivariate analysis, pretreatment with prasugrel was independently associated with MBG 3 (odds ratio = 3.93; 95% confidence interval = 1.01-15.39).
Prasugrel loading dose was associated with a lower percentage of cross-sections with residual thrombus area more than 10% as compared with both clopidogrel and ticagrelor, although intrastent thrombus volume was not significantly different between prasugrel and ticagrelor.The frequency of MBG 3 was the only reperfusion index that was significantly more prevalent in prasugrel treated group as compared with clopidogrel and ticagrelor groups.
我们试图评估不同口服P2Y12受体抑制剂对参加COCTAIL II试验的ST段抬高型心肌梗死患者残余血栓和再灌注指标的影响。该试验纳入了128例行直接经皮冠状动脉介入治疗的患者，随机分为冠状动脉内注射对比病变内注射阿昔单抗推注，伴或不伴血栓切除术。
患者分为三组：氯吡格雷组（n = 44）、普拉格雷组（n = 45）和替格瑞洛组（n = 39）。使用光学相干断层扫描技术，通过血栓面积超过10%的横截面数量和血栓体积来量化支架内残余血栓。再灌注指标包括心肌梗死溶栓（TIMI）血流、校正TIMI帧数、心肌 blush分级（MBG）和ST段完全回落（≥70%）。
与氯吡格雷组[8.0（1.0 - 15.0），P = 0.011]和替格瑞洛组[7.0（3.0 - 13.5），P = 0.026]相比，普拉格雷组光学相干断层扫描显示血栓面积超过10%的横截面百分比更低[4.0（1.0 - 8.5）]。氯吡格雷组的血栓体积为4.0mm³（2.7 - 6.2），高于普拉格雷组[2.8mm³（1.8 - 4.4），P = 0.023]，而其他组间比较无显著差异。普拉格雷组MBG 3的频率高于氯吡格雷组（45.5%）和替格瑞洛组（56.4%）[P = 0.027]。三组间最终TIMI血流、TIMI帧数和ST段回落情况无显著差异（P分别为0.423、0.179和0.848）。多因素分析显示，普拉格雷预处理与MBG 3独立相关（优势比 = 3.93；95%置信区间 = 1.01 - 15.39）。
与氯吡格雷和替格瑞洛相比，普拉格雷负荷剂量与血栓面积超过10%的横截面百分比更低相关，尽管普拉格雷和替格瑞洛之间支架内血栓体积无显著差异。MBG 3的频率是唯一在普拉格雷治疗组中比氯吡格雷和替格瑞洛组更普遍的再灌注指标。
