替格瑞洛与氯吡格雷治疗高龄急性冠脉综合征患者有效性和安全性比较

目的 探讨替格瑞洛与氯吡格雷治疗中国高龄非血运重建急性冠脉综合征（ACS）患者的有效性和安全性。方法 连续性纳入2012年5月～2020年9月空军军医大学第一附属医院心内科未行介入治疗的中国高龄（≥75岁）ACS患者106例，根据抗血小板药物分为氯吡格雷组（n=65）和替格瑞洛组（n=41），随访12个月，有效终点为主要不良心血管事件（MACE），是由全因死亡、非致命性心肌梗死和临床驱动的血运重建组成。安全性终点为出血学术研究会(BARC)标准规定的出血事件。结果 两组之间绝大部分基本资料、既往病史以及实验室数据等基线资料无显著性差异，而氯吡格雷组患者患慢性肾病者较多（P<0.05）。替格瑞洛组患者MACE发生率低于氯吡格雷组（4.9%vs. 18.5%），差异有统计学意义（P<0.05）。替格瑞洛组出血事件的发生率高于氯吡格雷组（7.3%vs. 3.1%），但差异无统计学意义。结论 与氯吡格雷相比，使用替格瑞洛可降低未行介入治疗的高龄ACS患者的MACE发生率,但未明显增加出血事件。

Comparison of safety and efficacy of ticagrelor and clopidogrel in treatment of elderly patients with acute coronary syndrome

AIM To explore the efficacy and safety of ticagrelor and clopidogrel in the treatment of acute coronary ayndrome (ACS) in Chinese elderly patients without revascularization. METHODS Continuously enrolled for this study were 106 Chinese elderly ACS patients (≥75 years old) who were not treated with interventional therapy in our department from May 2012 to September 2020. According to antiplatelet drugs, the enrolled patients were divided into clopidogrel group (n=65) and ticagrelor group (n=41) and the follow-up was 12 months. The effective end point was the major adverse cardiovascular event (MACE), which was composed of all-cause death, nonfatal myocardial infarction and clinically-driven revascularization. The safety endpoint is BARC bleeding event. RESULTS There were more patients with chronic kidney disease in the clopidogrel group (P<0.05) and there was no significant difference between the two groups in baseline data such as basic data, past medical history and laboratory data. The incidence of MACE in the ticagrelor group was lower than that in the clopidogrel group (4.9% vs. 18.5%) and the difference was statistically significant (P<0.05). The incidence of bleeding events in the ticagrelor group was higher than that in the clopidogrel group (7.3% vs. 3.1%) and the difference was not statistically significant. CONCLUSION Compared with clopidogrel, ticagrelor reduces the incidence of MACE in elderly ACS patients without interventional therapy, and it does not significantly increase bleeding events.