不同剂量替格瑞洛在老年急性心肌梗死病人PCI术后抗血小板治疗中的有效性与安全性

目的比较低剂量替格瑞洛(180 mg负荷量,续贯60 mg每日2次口服)与标准剂量替格瑞洛(180 mg负荷量,续贯90 mg每日2次口服)在老年急性心肌梗死(AMI)病人经皮冠状动脉介入术(PCI)术后抗PLT治疗中的有效性与安全性。方法研究共入选196例成功接受PCI治疗的老年AMI病人,随机分为低剂量替格瑞洛组和标准剂量替格瑞洛组,详细记录病人住院期间及随访1年的主要不良心脑血管事件(MACCE)与出血事件。结果低剂量替格瑞洛组住院期间及随访至1年MACCE发生率与标准剂量替格瑞洛组相比,差异无统计学意义。住院期间2组小出血(8.4%比18.6%,P=0.061)和大出血发生率(1.1%比2.9%,P=0.622)差异无统计学意义;低剂量替格瑞洛组随访1年小出血发生率显著低于标准剂量替格瑞洛组(16.8%比36.9%,P=0.002),大出血方面2组差异无统计学意义(1.1%比3.9%,P=0.371)。Kaplan-Meier生存分析显示,低剂量替格瑞洛组1年无MACCE生存率与标准剂量替格瑞洛组相比,差异无统计学意义(P=0.823)。结论AMI病人PCI术后接受小剂量替格瑞洛较常规剂量相比,不增加MACCE事件发生率,同时可降低小出血风险。

Efficacy and safety of different doses of ticagrelor in elderly patients with acute myocardial infarction after percutaneous coronary intervention

Objective To compare the efficacy and safety of antiplatelet therapy in the patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI)between low-dose ticagrelor(180 mg loading,60 mg twice daily)and standard-dose ticagrelor(180 mg loading,90 mg twice daily).Methods A total of 196 patients with AMI who were successfully treated by PCI were randomly divided into low-dose ticagrelor group and standard-dose ticagrelor group.The major adverse cardio-cerebrovascular events(MACCE)and bleeding events during hospitalization and one-year follow-up were recorded in detail.Results There was no significant difference in MACCE between low-dose ticagrelor group and standard-dose ticagrelor group during hospitalization(10.5%vs 11.7%,P=0.825).The risk of minor bleeding(8.4%vs 18.6%,P=0.061)and major bleeding(1.1%vs 2.9%,P=0.622)were comparable between the two groups.Kaplan-Meier survival analysis showed that there was no significant difference in 1-year MACCE-free survival rate between low-dose ticagrelor group and standard-dose ticagrelor group(P=0.823).The risk of minor bleeding was significantly lower in low-dose ticagrelor group than that in standard-dose ticagrelor group(16.8%vs 36.9%,P=0.002)1 year after PCI,and there was no significant difference in major bleeding(1.1%vs 3.9%,P=0.371).Conclusions Compared with the routine dose,low-dose ticagrelor does not increase the incidence of MACCE,while reduce the risk of minor bleeding in the patients with AMI after PCI.