Vicent Lourdes, Bruña Vanesa, Devesa Carolina, Sousa-Casasnovas Iago, Juárez Miriam, Alcalá Luis, Muñoz Patricia, Fernández-Avilés Francisco, Martínez-Sellés Manuel
Servicio de Cardiología, Hospital General Universitario 12 de Octubre, Madrid, Spain,
CIBER Enfermedades Cardiovasculares - CIBERCV, Madrid, Spain,
Cardiology. 2021;146(6):698-704. doi: 10.1159/000519285. Epub 2021 Sep 22.
Ticagrelor has a bactericidal effect in vitro, and clinical studies suggest a beneficial effect in infections. Our aim was to determine the incidence of infections in patients treated with 3 different P2Y12 receptor inhibitors.
Retrospective registry in a cardiology department. Patients with coronary artery disease discharged on ticagrelor, prasugrel, or clopidogrel from March 2017 to June 2019 were included. The risk of infection was analyzed during the period of P2Y12 inhibitor treatment (12.4 ± 6.7 months).
A total of 250 patients were included (ticagrelor 91 [36.4%], prasugrel 89 [35.6%], clopidogrel 70 [28.0%]). Mean age was 61.0 ± 13.1 years, and 63 (25.2%) were women. The most common reason to use these drugs was ST-segment elevation acute myocardial infarction (STEMI) (152 patients - 60.8%). STEMI was the reason to use prasugrel in 84 patients (94.4%), ticagrelor in 44 (48.4%), and clopidogrel in 24 (34.3%), p < 0.001. An infection during follow-up was seen in 87 patients (34.8%), 23 treated with ticagrelor (25.3%), 30 with prasugrel (33.7%) and 34 with clopidogrel (48.6%), p = 0.009. Ticagrelor was independently associated with a lower likelihood of infection (Hazard Ratio [HR] 0.52, 95% confidence interval [CI] 0.28-0.95; p = 0.035) compared to prasugrel (HR 0.96, 95% CI 0.54-1.73; p = 0.909) and clopidogrel (HR = 1).
In patients admitted with coronary artery disease patients treated with ticagrelor had a lower frequency of infections during follow-up than those treated with other P2Y12 inhibitors. Further studies are necessary to clarify the bactericidal effect of ticagrelor in this context.
替格瑞洛在体外具有杀菌作用，临床研究表明其对感染有有益影响。我们的目的是确定接受3种不同P2Y12受体抑制剂治疗的患者的感染发生率。
在心脏病科进行回顾性登记。纳入2017年3月至2019年6月期间出院时使用替格瑞洛、普拉格雷或氯吡格雷的冠心病患者。在P2Y12抑制剂治疗期间（12.4±6.7个月）分析感染风险。
共纳入250例患者（替格瑞洛91例[36.4%]，普拉格雷89例[35.6%]，氯吡格雷70例[28.0%]）。平均年龄为61.0±13.1岁，女性63例（25.2%）。使用这些药物的最常见原因是ST段抬高型急性心肌梗死（STEMI）（152例患者 - 60.8%）。STEMI是84例（94.4%）患者使用普拉格雷、44例（48.4%）患者使用替格瑞洛、24例（34.3%）患者使用氯吡格雷的原因，p<0.001。随访期间87例患者（34.8%）发生感染，23例接受替格瑞洛治疗（25.3%），30例接受普拉格雷治疗（33.7%），34例接受氯吡格雷治疗（48.6%），p = 0.009。与普拉格雷（风险比[HR]0.96，95%置信区间[CI]0.54 - 1.73；p = 0.909）和氯吡格雷（HR = 1）相比，替格瑞洛与感染可能性较低独立相关（HR 0.52，95%CI 0.28 - 0.95；p = 0.035）。
在冠心病住院患者中，接受替格瑞洛治疗的患者随访期间感染频率低于接受其他P2Y12抑制剂治疗的患者。需要进一步研究以阐明替格瑞洛在此背景下的杀菌作用。
