Ren C, Zhao W, Shen T, Xu X Y, Zhou L Q, Tao L Y, Gao W
Department of Cardiology, Peking University Third Hospital, Institute of Vascular Medicine, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides of National Health Commission, Key Laboratory of Molecular Cardiovascular Science of Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Feb 24;48(2):104-110. doi: 10.3760/cma.j.issn.0253-3758.2020.02.004.
To investigate the effects of ticagrelor on cardiorespiratory fitness in patients with coronary heart disease after percutaneous coronary intervention (PCI). A total of 1 073 patients, who were diagnosed as coronary heart disease and underwent cardiopulmonary exercise testing (CPET) within 1 year after PCI, were enrolled from September 2017 to September 2019 in Peking University Third Hospital, including 309 patients in ticagrelor group and 764 patients in clopidogrel group. Clinical information, blood test results, echocardiographic parameters, cardiorespiratory fitness related parameters (including peak oxygen uptake (VO(2)), anaerobic threshold VO(2), peak oxygen pulse (VO(2)/HR) and carbon dioxide ventilation equivalent (VE/VCO(2)) slope), coronary lesions and intervention information were obtained. Cardiopulmonary fitness related indexes were compared between the two groups, and the correlation between ticagrelor use and cardiopulmonary fitness related indexes was analyzed by multivariate logistic regression. Patients who underwent CPET within 1 month after PCI were included in the subgroup analysis. In ticagrelor group, the age was (60.3±10.3) years, and 253(81.9%) cases were male. The age of clopidogrel group was (60.6±10.0) years, and there were 608(79.6%) males. No significant differences were observed in peak VO(2), anaerobic threshold VO(2), and peak VO(2)/HR between the two groups (all >0.05), but the VE/VCO(2) slope was significantly higher in the ticagrelor group than in the clopidogrel group (30.075 (27.207, 33.603) vs. 28.853 (25.970, 32.336), 0.001). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with the ticagrelor use (all >0.05), while the VE/VCO(2) slope was independently correlated with ticagrelor use (1.098, 95 1.032-1.168, 0.003). Subgroup analysis of patients who underwent CPET within 1 month after PCI also indicated that no significant difference were observed in peak VO(2), anaerobic threshold VO(2), peak VO(2)/HR and VE/VCO(2) slope between the two groups (all 0.05). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with ticagrelor use (all 0.05), while the VE/VCO(2) slope was significantly correlated with ticagrelor use (1.132, 95 1.030-1.244, 0.010). Among coronary heart disease patients after PCI, treatment with clopidogrel does not result in significant decrease in exercise endurance as compared with patients treated with ticagrelor.
探讨替格瑞洛对冠心病患者经皮冠状动脉介入治疗(PCI)后心肺适能的影响。2017年9月至2019年9月,在北京大学第三医院纳入1073例诊断为冠心病且在PCI术后1年内接受心肺运动试验(CPET)的患者,其中替格瑞洛组309例,氯吡格雷组764例。获取临床资料、血液检查结果、超声心动图参数、心肺适能相关参数(包括峰值摄氧量(VO₂)、无氧阈VO₂、峰值氧脉搏(VO₂/HR)和二氧化碳通气当量(VE/VCO₂)斜率)、冠状动脉病变及介入信息。比较两组心肺适能相关指标,采用多因素logistic回归分析替格瑞洛使用与心肺适能相关指标的相关性。将PCI术后1个月内接受CPET的患者纳入亚组分析。替格瑞洛组患者年龄为(60.3±10.3)岁,男性253例(81.9%)。氯吡格雷组患者年龄为(60.6±10.0)岁,男性608例(79.6%)。两组间峰值VO₂、无氧阈VO₂和峰值VO₂/HR比较差异均无统计学意义(均>0.05),但替格瑞洛组VE/VCO₂斜率显著高于氯吡格雷组(30.075(27.207,33.603)比28.853(25.970,32.336),P=0.001)。logistic回归分析显示,峰值VO₂、无氧阈VO₂和峰值VO₂/HR与替格瑞洛使用无显著相关性(均>0.05),而VE/VCO₂斜率与替格瑞洛使用独立相关(1.098,95%CI 1.032-1.168,P=0.003)。对PCI术后1个月内接受CPET的患者进行亚组分析,结果显示两组间峰值VO₂、无氧阈VO₂、峰值VO₂/HR和VE/VCO₂斜率比较差异均无统计学意义(均>0.05)。logistic回归分析显示,峰值VO₂、无氧阈VO₂和峰值VO₂/HR与替格瑞洛使用无显著相关性(均>0.05),而VE/VCO₂斜率与替格瑞洛使用显著相关(1.132,95%CI 1.030-1.244,P=0.010)。在PCI术后冠心病患者中,与接受替格瑞洛治疗的患者相比,氯吡格雷治疗不会导致运动耐力显著下降。