Wang Xuechao, Li Xinning, Wu Haibo, Li Ruyi, Liu Huiliang, Wang Lili, Bai Shiru, Zhang Lina, Chen Tianlei, Liu Jia, Li Qi, Du Rongpin
Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China.
Coron Artery Dis. 2019 Aug;30(5):317-322. doi: 10.1097/MCA.0000000000000707.
Ticagrelor significantly reduced the incidence of death, myocardial infarction, and stent thrombosis in patients with ST-segment elevation myocardial infarction (STEMI) intended for reperfusion with a primary percutaneous coronary intervention (pPCI). However, the effects of this drug on microvascular perfusion in patients presenting with STEMI have not been evaluated completely.
A total of 298 patients presenting with STEMI were randomized to either ticagrelor 180 mg loading, followed by 90 mg twice daily, or clopidogrel 600 mg loading, followed by 75 mg daily. The primary endpoint was ST-segment resolution at 90 min after pPCI. The secondary endpoints included myocardial blush grade and corrected thrombolysis in myocardial infarction frame count after the procedure. Left ventricular ejection fraction and major adverse cardiac events (MACE) at the 1- and 6-month follow-up time points were also recorded.
There were no significant differences between the two groups with respect to baseline characteristics. Ticagrelor administration resulted in a higher rate of completed ST-segment resolution (58.67 vs. 39.86%, P=0.001), higher myocardial blush grade (2.63±0.64 vs. 2.41±0.71, P=0.005), and lower corrected thrombolysis in myocardial infarction frame count (19.68±7.38 vs. 22.35±8.30, P=0.004). At 6 months, left ventricular ejection fraction was higher (55.01±8.44 vs. 52.34±9.05%, P=0.009) in the ticagrelor group. Kaplan-Meier analysis showed that MACE-free survival had also improved in the ticagrelor group during the 1- and 6-month follow-up time points.
Compared with clopidogrel, ticagrelor improves myocardial perfusion and left ventricular ejection fraction, and reduces the incidence of MACE for STEMI patients undergoing pPCI, with no significant increase in major bleeding.
替格瑞洛显著降低了接受直接经皮冠状动脉介入治疗（pPCI）进行再灌注的ST段抬高型心肌梗死（STEMI）患者的死亡、心肌梗死和支架血栓形成的发生率。然而，这种药物对STEMI患者微血管灌注的影响尚未得到全面评估。
总共298例STEMI患者被随机分为两组，一组给予替格瑞洛180mg负荷剂量，随后每日两次，每次90mg；另一组给予氯吡格雷600mg负荷剂量，随后每日75mg。主要终点是pPCI术后90分钟时ST段回落情况。次要终点包括术后心肌 blush分级和校正的心肌梗死溶栓帧数。还记录了1个月和6个月随访时间点的左心室射血分数和主要不良心脏事件（MACE）。
两组在基线特征方面无显著差异。使用替格瑞洛导致ST段完全回落率更高（58.67%对39.86%，P = 0.001），心肌 blush分级更高（2.63±0.64对2.41±0.71，P = 0.005），校正的心肌梗死溶栓帧数更低（19.68±7.38对22.35±8.30，P = 0.004）。在6个月时，替格瑞洛组的左心室射血分数更高（55.01±8.44%对52.34±9.05%，P = 0.009）。Kaplan-Meier分析表明，在1个月和6个月随访时间点，替格瑞洛组无MACE生存情况也有所改善。
与氯吡格雷相比，替格瑞洛可改善心肌灌注和左心室射血分数，并降低接受pPCI的STEMI患者的MACE发生率，且大出血无显著增加。
