Zhang Yunke, Hui Jie, Chen Xia
Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Department of Cardiology, Shanghai University of Medicine and Health Sciences Affiliated Jiading Central Hospital, Shanghai, 201800, People's Republic of China.
Int J Gen Med. 2021 May 18;14:1927-1938. doi: 10.2147/IJGM.S307404. eCollection 2021.
The purpose of this monocentric retrospective observational study is to investigate whether a loading dose of ticagrelor treatment before percutaneous coronary intervention (PCI) procedure improves the early reperfusion and short-term heart function in East-Asian ST segment elevation myocardial infarction (STEMI) patients.
The study included 326 STEMI patients undergoing primary PCI in Jiading Central Hospital. One hundred and forty patients received a loading dose of ticagrelor before entering the catheter laboratory. One hundred and eighty-six patients received a loading dose of ticagrelor in the catheter laboratory before the initiation of PCI. Reperfusion endpoints included the presence of self-patency in the culprit artery, the ST-segment elevation resolution over 50% within 24 h after PCI, and the presence of no-reflow in the culprit artery. Clinical endpoints included all-cause mortality, new-onset heart failure, reinfarction and stent thrombosis within 28 days after PCI. Secondary clinical endpoints included mechanical complications and bleeding events.
In comparison with the in-lab treatment group, the preprocedural treatment group had a significant higher proportion of self-patency in the culprit artery (25.71% vs 16.67%, =0.045) and early ST-segment elevation resolution (48.57% vs 27.96%, <0.001). Preprocedural ticagrelor treatment was associated with a significant reduction of new-onset heart failure (9.29% vs 18.82%, p=0.016). Stent thrombosis risks were numerically reduced in the preprocedural treatment group (0.71% vs 1.61%, =0.466). The rates of major cardiovascular adverse events, reinfarctions and mortality did not differ between the two groups. Bleeding events in the preprocedural treatment group was notn significantly higher than the in-lab treatment group (4.39% vs 1.39%, =0.142).
Preprocedural administration of a loading dose of ticagrelor was associated with improved early reperfusion and reduced short-term heart failure in East-Asian STEMI patients undergoing primary PCI, but care should be taken for excess bleeding events.
本单中心回顾性观察研究旨在探讨经皮冠状动脉介入治疗（PCI）术前给予替格瑞洛负荷剂量治疗是否能改善东亚ST段抬高型心肌梗死（STEMI）患者的早期再灌注及短期心脏功能。
本研究纳入了326例在嘉定中心医院接受直接PCI的STEMI患者。140例患者在进入导管室前接受替格瑞洛负荷剂量治疗。186例患者在PCI开始前在导管室内接受替格瑞洛负荷剂量治疗。再灌注终点包括罪犯血管自发开通、PCI术后24小时内ST段抬高回落超过50%以及罪犯血管无复流现象。临床终点包括PCI术后28天内的全因死亡率、新发心力衰竭、再梗死和支架血栓形成。次要临床终点包括机械并发症和出血事件。
与导管室内治疗组相比，术前治疗组罪犯血管自发开通比例显著更高（25.71%对16.67%，P = 0.045），且早期ST段抬高回落更明显（48.57%对27.96%，P < 0.001）。术前替格瑞洛治疗与新发心力衰竭显著减少相关（9.29%对18.82%，P = 0.016）。术前治疗组支架血栓形成风险在数值上有所降低（0.71%对1.61%，P = 0.466）。两组主要心血管不良事件、再梗死和死亡率无差异。术前治疗组出血事件发生率虽高于导管室内治疗组，但差异无统计学意义（4.39%对1.39%，P = 0.142）。
对于接受直接PCI的东亚STEMI患者，术前给予替格瑞洛负荷剂量治疗可改善早期再灌注并减少短期心力衰竭，但应注意出血事件增多。
