Liu Y, Ding L-Y, Li X-Z
Department of Special Examination, Binzhou City Center Hospital, Binzhou, China.
Eur Rev Med Pharmacol Sci. 2019 Aug;23(3 Suppl):312-318. doi: 10.26355/eurrev_201908_18662.
To investigate the protective effect of ticagrelor on the myocardium of patients with ST-elevated acute coronary syndrome accompanied by diabetes mellitus.
210 patients with diabetes mellitus receiving emergency percutaneous coronary intervention (PCI) due to ST-elevated acute coronary syndrome from December 2014 to June 2018 in the Hospital were selected and randomly divided into ticagrelor group and clopidogrel group. The myocardial microcirculation perfusion was evaluated via ST-segment elevation resolution (STR) in electrocardiogram (ECG) and myocardial blush grade (MBG). Myocardial necrosis markers, including creatine kinase (CK), CK-MB, and cardiac troponin I (cTnI), were evaluated. Moreover, the cardiac function was assessed using brain natriuretic peptide (BNP) level and left ventricular ejection fraction (LVEF). Finally, patients were followed up for one month on average, and the adverse cardiovascular and bleeding events were recorded.
The results showed that CK, CK-MB, cTnI, and BNP levels in ticagrelor group were lower than those in clopidogrel group, and the differences were statistically significant (p<0.05). Thrombolysis in myocardial infarction (TIMI) flow grading after the operation had no statistically significant difference between the two groups, and the usage rate of tirofiban in ticagrelor group was lower than that in clopidogrel group (p<0.05). Besides, the myocardial microcirculation perfusion level after the operation in ticagrelor group was significantly higher than that in clopidogrel group. The proportions of STR ≥50% in ECG and MBG2 in ticagrelor group were significantly higher than those in clopidogrel group (p<0.01). The incidence rate of mild bleeding in ticagrelor group was higher than that in clopidogrel group (p<0.05).
The application of ticagrelor in the treatment of ST-elevated acute coronary syndrome accompanied by diabetes mellitus can increase the level of myocardial microcirculation perfusion and improve the left heart function.
探讨替格瑞洛对ST段抬高型急性冠脉综合征合并糖尿病患者心肌的保护作用。
选取2014年12月至2018年6月在我院因ST段抬高型急性冠脉综合征接受急诊经皮冠状动脉介入治疗（PCI）的210例糖尿病患者，随机分为替格瑞洛组和氯吡格雷组。通过心电图（ECG）的ST段抬高分辨率（STR）和心肌 blush 分级（MBG）评估心肌微循环灌注。评估心肌坏死标志物，包括肌酸激酶（CK）、CK-MB和心肌肌钙蛋白I（cTnI）。此外，使用脑钠肽（BNP）水平和左心室射血分数（LVEF）评估心功能。最后，对患者平均随访1个月，记录不良心血管事件和出血事件。
结果显示，替格瑞洛组的CK、CK-MB、cTnI和BNP水平低于氯吡格雷组，差异有统计学意义（p<0.05）。术后心肌梗死溶栓（TIMI）血流分级两组间无统计学差异，替格瑞洛组替罗非班使用率低于氯吡格雷组（p<0.05）。此外，替格瑞洛组术后心肌微循环灌注水平显著高于氯吡格雷组。替格瑞洛组心电图STR≥50%和MBG2的比例显著高于氯吡格雷组（p<0.01）。替格瑞洛组轻度出血发生率高于氯吡格雷组（p<0.05）。
替格瑞洛应用于治疗ST段抬高型急性冠脉综合征合并糖尿病可提高心肌微循环灌注水平，改善左心功能。
