替格瑞洛辅助急诊PCI治疗STEMI对患者心室重构影响情况分析

目的 探讨ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)行急诊经皮冠脉介入术(percutaneous coronary intervention,PCI)患者加用替格瑞洛治疗的临床效果及对患者心室重构的影响.方法 选取我院急诊PCI手术治疗的STEMI患者120例(2014年1月至2016年8月)进行回顾性分析,患者均急诊PCI手术,根据治疗药物分为两组,60例患者术前及术后均给予替格瑞洛(替格瑞洛组)、60例患者术前及术后均给予氯吡格雷(氯吡格雷组),对比两组患者术后心室重构指标、心电图等指标.结果 术后12周,替格瑞洛组LVEDd (49.1±5.4)mm、LVESD (40.6±4.6)mm、LVMI(112.8±11.0) g/m2、LVMW(140.7 ±18.5)g低于氯吡格雷组患者LVEDd(53.1±4.6) mm、LVESD (43.9±4.7) mm、LVMI(118.2 ±9.4)g/m2、LVMW(153.0±21.3) g(t =4.638、t=3.887、t=2.891、t =2.198,P均＜0.05),两组患者的LVEF值差异无统计学意义(t=1.064,P ＞0.05);术后12周,替格瑞洛组Tp-e(114.2±12.7) ms、Tp-e/QTc(0.20±0.05)低于氯吡格雷组患者Tp-e(120.6±13.9)ms、Tp-e/QTc (0.25±0.07)(t=2.633、t=4.502,P ＜0.05);替格瑞洛组的不良心血管事件发生率6.67％与氯吡格雷组的13.33％比较,差异无统计学意义(x2=1.481,P＞0.05).讨论 STEMI行PCI患者加用替格瑞洛治疗能有效减轻心室重构,改善心电图指标.

Effect of ticagrelor on ventricular remodeling in patients with STEMI undergoing emergency PCI

Objective To investigate the clinical efficacy of ticagrelor in treatment of ST-segment elevation myocardial infarction (STEMI) patients before and after emergency percutaneous coronary intervention (PCI),and determine its effect on the ventricular remodeling.Methods A retrospective analysis was conducted on 120 STEMI patients who underwent emergency PCI in our hospital from January 2014 to August 2016.According to their drug treatment,they were divided into ticagrelor group (n =60,given ticagrelor pre-and post-operatively) and clopidogrel group (n =60,given clopidogrel pre-and postoperatively).The indexes of ventricular remodeling,electrocardiography (ECG) parameters and other indexes were compared between the 2 groups.Results In 12 weeks after operation,the ticagrelor group had significantly lower left ventricular end diastolic diameter (LVEDd,49.1 ±5.4 vs 53.1-±4.6 mm,t =4.638,P ＜ 0.05),left ventricular end systolic diameter (LVESD,40.6 ± 4.6 vs 43.9 ± 4.7 mm,t =3.887,P ＜0.05),left ventricular mass index (LVMI,112.8 ± 11.0 vs 118.2 ± 9.4 g/m2,t =2.891,P ＜ 0.05),and left ventricular mass (LVMW,140.7 ± 18.5 vs 153 ±21.3 g,t =2.198,P ＜0.05) when compared with the clopidogrel group.But no difference was seen in left ventricular ejection fraction (LVEF) between them (t =1.064,P ＞ 0.05).What's more,the T wave (Tp-e) interval and the Tp-e/QT ratio were obviously lower in the ticagrelor group than the other group (114.2-± 12.7 vs 120.6 ± 13.9 ms,t =2.633,P ＜0.05;0.20 ±0.05 vs 0.25 ± 0.07,t =4.502,P ＜ 0.05).There was no notable difference in the incidence of adverse cardiovascular events between them (6.67％ vs 13.33％,Chi-square =1.481,P ＞ 0.05).Conclusion Additional ticagrelor treatment can effectively reduce ventricular remodeling and improve ECG indicators in STEMI patients undergoing PCI.