Yeh Chia-Hung, Chung Wen-Jung, Chen Tien-Yu, Wu Po-Jui, Tseng Chien-Hao, Lee Chien-Ho, Cheng Cheng-I
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital.
Chang Gung University School of Medicine, Kaohsiung, Taiwan.
Acta Cardiol Sin. 2023 Jan;39(1):116-126. doi: 10.6515/ACS.202301_39(1).20220601A.
Few studies have investigated the clinical efficacy and pulmonary side effects of different P2Y12 inhibitors in acute coronary syndrome (ACS) patients. The aim of this study was to explore the impact of forced expiratory volume in 1 second over forced vital capacity (FEV1/FVC) ratio on the clinical outcomes in ACS patients treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI).
ACS patients who underwent PCI, had documented pre-existing spirometry tests, and received aspirin with either ticagrelor or clopidogrel were enrolled for retrospective analysis.
Of the enrolled ACS patients, 275 and 247 received ticagrelor and clopidogrel, respectively. The incidence of wheeze was significantly higher in the ticagrelor group compared to the clopidogrel group within 360 days (14.91% vs. 8.09%, p = 0.016). Multivariable analysis revealed that ticagrelor treatment, as compared to clopidogrel treatment, independently predicted 1-year hospitalization for acute exacerbation (AE) of obstructive airway disease (hazard ratio: 3.44; 95% confidence interval: 1.92 to 6.15; p < 0.01). The receiver operating characteristic curve indicated that an FEV1/FVC ratio of 63.85% had the highest sensitivity and specificity for predicting the incidence of AE of obstructive airway disease within 1 year (p < 0.001). The 1-year hospitalization rate for AE of obstructive airway disease was significantly higher in the ticagrelor group when the FEV1/FVC ratio was < 63%.
This study demonstrated higher incidence of wheeze and hospitalization for AE of obstructive airway disease in ACS patients treated with ticagrelor compared to clopidogrel. Furthermore, the FEV1/FVC ratio ≤ 63% in the ACS patients predicted hospitalization for AE of obstructive airway disease in 1 year.
很少有研究调查不同P2Y12抑制剂在急性冠状动脉综合征（ACS）患者中的临床疗效和肺部副作用。本研究的目的是探讨经皮冠状动脉介入治疗（PCI）后接受双联抗血小板治疗的ACS患者中，一秒用力呼气容积与用力肺活量之比（FEV1/FVC）对临床结局的影响。
纳入接受PCI、有既往肺功能检查记录且接受阿司匹林联合替格瑞洛或氯吡格雷治疗的ACS患者进行回顾性分析。
在纳入的ACS患者中，分别有275例和247例接受了替格瑞洛和氯吡格雷治疗。在360天内，替格瑞洛组的喘息发生率显著高于氯吡格雷组（14.91%对8.09%，p = 0.016）。多变量分析显示，与氯吡格雷治疗相比，替格瑞洛治疗独立预测阻塞性气道疾病急性加重（AE）的1年住院率（风险比：3.44；95%置信区间：1.92至6.15；p < 0.01）。受试者工作特征曲线表明，FEV1/FVC比值为63.85%时，预测1年内阻塞性气道疾病AE发生率的敏感性和特异性最高（p < 0.001）。当FEV1/FVC比值< 63%时，替格瑞洛组阻塞性气道疾病AE的1年住院率显著更高。
本研究表明，与氯吡格雷相比，接受替格瑞洛治疗的ACS患者中，阻塞性气道疾病AE的喘息和住院发生率更高。此外，ACS患者中FEV1/FVC比值≤ 63%可预测1年内阻塞性气道疾病AE的住院情况。
