Clinical Impact of Enhanced Inhibition of P2Y12-Mediated Platelet Aggregation in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Abstract

The combination of aspirin and clopidogrel at a loading dose of 300 mg followed by a maintenance dose of 75 mg daily is a well-established antiplatelet therapy for the secondary prevention of thrombotic complications in the settings of acute coronary syndrome and/or percutaneous coronary intervention (PCI). Despite the demonstrated clinical benefits associated with this antiplatelet therapy, there is accumulating evidence that a consistent proportion of patients persist in having high levels of platelet aggregation following standard clopidogrel dose. Importantly, the high platelet reactivity after clopidogrel treatment has been associated with higher risk for cardiovascular ischemic events, including stent thrombosis. This has warranted the need for alternative oral antiplatelet regimens that achieve a higher degree of platelet inhibition. Several functional studies have shown that a higher clopidogrel loading dose (600 mg) compared with standard dose, and novel oral adenosine diphosphate platelet receptor (P2Y₁₂) antagonists compared with clopidogrel achieve a faster onset of action, increased platelet inhibition, and a more predictable drug response. These more favorable pharmacodynamic characteristics are of particular interest in the setting of primary PCI for ST-segment elevation myocardial infarction (STEMI), in which rapid and consistent inhibition of platelet activation and aggregation is desirable for therapeutic success. The present article reviews data on the clinical impact of enhanced P2Y₁₂ inhibition with either higher clopidogrel dosing or new oral antiplatelet agents, including prasugrel and ticagrelor, in the setting of STEMI, focusing on results in the setting of primary PCI.     

不同负荷剂量氯吡格雷治疗急性冠脉综合征的临床应用研究

目的比较不同负荷剂量氯吡格雷在经皮冠脉介入治疗(PCI)术前应用对治疗急性冠脉综合征(ACS)的有效性和安全性,对更高负荷剂量的氯吡格雷安全性进行评估。方法120例诊断为ACS的患者随机分为A、B、C三组(na=nb=nc=40),三组患者临床基本资料差异无统计学意义(p>0.05)。A、B、C三组分别于术前6h给予600mg、450mg和300mg负荷剂量氯吡格雷,观察服药前?服药后2h、4h、6h血小板聚集率,30天主要终点事件(住院期间休克、死亡、靶血管重建、再发心梗、心绞痛、脑卒中)及术后30天出血事件和不良反应发生情况。结果与标准的300mg方案相比,氯吡格雷600mg比氯吡格雷450mg前6h内对血小板激活的抑制程度更大。氯吡格雷负荷剂量的增加可减少30天主要心血管事件的发生率。三组30天出血事件和不良事件发生情况差异无统计学意义(p>0.05)。结论与300mg氯吡格雷负荷剂量相比,较高的氯吡格雷负荷剂量能够产生更快、更强的血小板抑制,且安全性相似。     

Latest evidence in personalized antiplatelet therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention

In patients with acute coronary syndromes undergoing percutaneous coronary intervention, the combination of aspirin and clopidogrel, a P2Y12 adenosine diphosphate (ADP) receptor antagonist, is the gold standard of antiplatelet therapy. Two more potent P2Y12 ADP receptor antagonists are now available. Pharmacodynamic studies have revealed a large interindividual variability in the biological response to clopidogrel that is primarily related to variable active metabolite generation, depending on clinical factors, drug-drug interactions, and genetic polymorphisms. Several assays to measure platelet function are available and have revealed a high prevalence of high on-treatment platelet reactivity (HTPR). Patients exhibiting HTPR after a clopidogrel loading dose have a higher risk of thrombotic recurrence after percutaneous coronary intervention. A recent consensus has defined HTPR for the main platelet assays available (using receiver operating characteristic curve analysis) to define the optimal cutoff value for each assay in order to predict thrombotic recurrences. In this article, we present several lines of evidence that suggest a therapeutic window of platelet reactivity inhibition with P2Y12 ADP receptor antagonists. Such a paradigm shift is supported by the results of the Platelet Inhibition and Patient Outcomes (PLATO) trial and the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel-Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38, which showed the superiority of ticagrelor and prasugrel on thrombotic events compared with clopidogrel; however, these 2 medications had an increased bleeding rate. With the results of these trials, in addition to the evidence of a therapeutic window with P2Y12 ADP receptor antagonists, we summarize the potential of platelet reactivity monitoring and pharmacogenomics to tailor therapy.     

Clinical update on the therapeutic use of clopidogrel: treatment of acute ST-segment elevation myocardial infarction (STEMI)

The pathogenesis of ST-elevation myocardial infarction (STEMI) involves plaque disruption, platelet aggregation and intracoronary artery thrombus formation. Aspirin is the cornerstone of antiplatelet therapy in patients with STEMI, reducing the risk of recurrent myocardial infarction or death during the acute phase and long term by about one-quarter. Recent large randomized trials have demonstrated that the addition of clopidogrel to aspirin reduces the risk of major ischemic events by up to a further one-third in patients with STEMI treated with fibrinolytic therapy and undergoing percutaneous coronary intervention, with no significant increase in bleeding. Thus, dual antiplatelet therapy with the combination of clopidogrel and aspirin is becoming the new standard of care for the management of patients with STEMI.     

Dosing Strategies for Antiplatelet Therapy in Percutaneous Coronary Intervention

Abstract

Both clopidogrel and aspirin have been shown to decrease the rate of cardiovascular events and especially stent thrombosis in patients undergoing percutaneous coronary intervention (PCI). However, recent studies have suggested that there is large inter-individual response variability to these drugs (especially to clopidogrel) and that improved inhibition of platelet reactivity using higher doses or new, more potent agents would further reduce the occurrence of cardiovascular events, but may also increase the risk of bleeding. Many different protocols of antiplatelet therapy have been studied and have shown benefit in reducing the rate of major adverse cardiovascular events after PCI. Therefore, the choice of an appropriate antiplatelet therapy protocol is sometimes difficult for the clinician and should be individualized as per the particular patient risk, accounting for both the risk of recurrent cardiovascular events and bleeding. We review the recent data on efficacy and safety of dosing strategies for antiplatelet therapy in PCI.     

Emerging oral antiplatelet therapies for acute coronary syndromes

Emergency department physicians, along with hospitalists and interventional cardiologists, provide first-line care for patients experiencing symptoms potentially associated with acute coronary syndromes (ACS). Because these health care providers encounter and manage patients with varying degrees of risk, a clear understanding of the modes of action, benefits, and limitations of various therapeutic options is crucial for achieving optimal outcomes in the acute-care setting. Oral antiplatelet therapy has a major role in the acute care of patients with suspected ACS due to the critical role of platelets in the pathophysiology of disease. The current standard-of-care oral antiplatelet therapy for ACS is aspirin in combination with a P2Y12 adenosine diphosphate (ADP) receptor antagonist, most commonly clopidogrel. Aspirin and P2Y12 antagonists have both demonstrated efficacy in reducing morbidity and mortality in patients with ACS, but are also associated with increased bleeding risk compared with controls. Additionally, despite dual oral antiplatelet therapy, patients remain at substantial residual risk for ischemic events due to thrombotic episodes driven by platelet activation pathways that are not inhibited by these agents, including the protease-activated receptor (PAR)-1 platelet activation pathway, stimulated by thrombin. Novel oral antiplatelet agents in advanced clinical development include a direct and more readily reversible P2Y12 antagonist, ticagrelor, as well as a new class of PAR-1 antagonists, which includes vorapaxar and atopaxar. Ticagrelor has shown a significant ischemic benefit and an increase in non-surgical bleeding over clopidogrel in the large phase 3 Platelet Inhibition and Patient Outcomes trial. Results of phase 2 trials with PAR-1 antagonists suggest that these agents may provide incremental reduction in ischemic events without a bleeding liability. This hypothesis is being evaluated in 2 large ongoing phase 3 trials with vorapaxar, including the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRA*CER) trial in patients with non-ST-segment elevation ACS.     

不同剂量阿司匹林及氯吡格雷对冠心病患者阿司匹林抵抗的影响

目的 观察不同剂量阿司匹林及氯吡格雷对冠心病阿司匹林抵抗（AR）患者血小板聚集功能的影响。方法筛选出冠心病患者中发生AR的患者90例,随机分为3组,分别给予口服阿司匹林100mg,300mg及氯吡格雷75mg＋阿司匹林100mg治疗,4周后采用全血电阻法检测血小板聚集率。结果 阿司匹林100mg和阿司匹林300mg组患者的血小板聚集率比较差异无统计学意义,而加用氯吡格雷组患者血小板聚集率明显降低（P〈0.05）。结论 加大阿司匹林剂量不能明显改善冠心病患者的AR,而加服氯吡格雷能有效抑制血小板聚集,减少患者AR的发生率,同时对AR患者应加强临床观察和护理干预。     

替格瑞洛联合比伐卢定对STEMI急诊PCI无复流临床研究

目的探讨新型抗栓药物替格瑞洛和比伐卢定在急性ST段抬高型心肌梗死(STEMI)急诊PCI中早期联合应用对无复流现象的预防效果。方法选取2012年5月²013年12月就诊于心内科且符合纳入、排除标准的患者67例作为研究对象。依据就诊顺序随机分为对照组(32例)和治疗组(35例)。对照组术前给予口服阿司匹林和氯吡格雷,术中给予肝素,治疗组术前给予阿司匹林替格瑞洛、术中给予比伐卢定治疗。于给药前和术后分别记录两组TIMI血流分级、校正的TIMI帧数(CTFC)以及无复流率。给药前,两组在一般情况和TIMI血流分级上均无统计学差异(p>0.05),具有可比性。结果术后,治疗组的TIMI血流分级高于对照组(p<0.05),治疗组的无复流率和CTFC较对照组低(p<0.05)。结论对STEMI患者行急诊PCI时,早期联合应用替格瑞洛和比伐卢定能较好地预防无复流现象。     

Latest Evidence in Personalized Antiplatelet Therapy in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

Abstract

In patients with acute coronary syndromes undergoing percutaneous coronary intervention, the combination of aspirin and clopidogrel, a P2Y₁₂ adenosine diphosphate (ADP) receptor antagonist, is the gold standard of antiplatelet therapy. Two more potent P2Y₁₂ ADP receptor antagonists are now available. Pharmacodynamic studies have revealed a large interindividual variability in the biological response to clopidogrel that is primarily related to variable active metabolite generation, depending on clinical factors, drug–drug interactions, and genetic polymorphisms. Several assays to measure platelet function are available and have revealed a high prevalence of high on-treatment platelet reactivity (HTPR). Patients exhibiting HTPR after a clopidogrel loading dose have a higher risk of thrombotic recurrence after percutaneous coronary intervention. A recent consensus has defined HTPR for the main platelet assays available (using receiver operating characteristic curve analysis) to define the optimal cutoff value for each assay in order to predict thrombotic recurrences. In this article, we present several lines of evidence that suggest a therapeutic window of platelet reactivity inhibition with P2Y₁₂ ADP receptor antagonists. Such a paradigm shift is supported by the results of the Platelet Inhibition and Patient Outcomes (PLATO) trial and the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38, which showed the superiority of ticagrelor and prasugrel on thrombotic events compared with clopidogrel; however, these 2 medications had an increased bleeding rate. With the results of these trials, in addition to the evidence of a therapeutic window with P2Y₁₂ ADP receptor antagonists, we summarize the potential of platelet reactivity monitoring and pharmacogenomics to tailor therapy.     

Current oral antiplatelets: focus update on prasugrel

Platelet activation and aggregation plays an integral role in the pathogenesis of acute coronary syndrome (ACS). The mainstay of ACS treatment revolves around platelet inhibition. It is known that greater platelet inhibition results in better ischemic outcomes; hence, focus in drug development has been to create more potent inhibitors of platelet aggregation. Prasugrel, a potent, third-generation thienopyridine, was approved by the US Food and Drug Administration in July 2009 for its use in ACS and percutaneous coronary intervention. The addition of prasugrel to aspirin for dual antiplatelet therapy has been shown to reduce the ischemic outcomes compared with clopidogrel and aspirin in combination. However, being a more potent antiplatelet agent, prasugrel increases the risk of bleeding, especially in those patients who are at a higher risk of bleeding complications. Elderly patients ≥75 years, patients who weigh ≥60 kg, and patients with a history of stroke or transient ischemic attack are at a higher risk of bleeding complications when prasugrel is used in combination with aspirin. Newer antiplatelets currently are being clinically evaluated to assess their efficacy in reducing ischemic events without increasing the bleeding risk.     

Platelet inhibitors in non-ST-segment elevation acute coronary syndromes and percutaneous coronary intervention: glycoprotein IIb/IIIa inhibitors, clopidogrel, or both?

The role of glycoprotein (Gp) IIb/IIIa receptor antagonists remains controversial and these agents are infrequently utilized during non-ST-segment elevation acute coronary syndromes (NSTE-ACS) despite American Heart Association/American College of Cardiology guidelines. Despite recommendations, the NRMI-4 (National Registry of Myocardial Infarction 4) and CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines?) registries observed that only 25%-32% of eligible patients received early Gp IIb/IIIa therapy, despite a 6.3% absolute mortality reduction in NRMI-4 and a 2% absolute mortality reduction in CRUSADE. A pooled analysis of Gp IIb/IIIa data from these registries suggest a major reduction in mortality (Odds Ratio = 0.43, 95% Confidence Index 0.25-0.74, p = 0.002) with early Gp IIb/IIIa therapy, yet clinicians fail to utilize this option in NSTE-ACS. The evidence-based approach to NSTE-ACS involves aspirin, clopidogrel, low-molecular weight heparins, or unfractionated heparin in concert with Gp IIb/Ila receptor antagonists, however, newer percutaneous coronary intervention (PCI)-based trials challenge current recommendations. Novel strategies emerging in NSTE-ACS include omitting Gp IIb/Ila inhibitors altogether or using Gp IIb/IIIa inhibitors with higher doses of clopidogrel in selected patients. The ISAR-REACT (Intracoronary stenting and antithrombotic regimen-Rapid early action for coronary treatment) and ISAR-SWEET (ISAR-Is abciximab a superior way to eliminate elevated thrombotic risk in diabetics) trials question the value of abciximab when 600 mg of clopidogrel concurrently administered during PCI. The CLEAR-PLATELETS (Clopidogrel loading with eptifibatide to arrest the reactivity of platelets) and PEACE (Platelet activity extinction in non-Q-wave MI with ASA, clopidogrel, and eptifibatide) trials suggest more durable platelet inhibition when Gp IIb/IIIa inhibitors are used with higher doses clopidogrel. The ISAR-COOL (ISAR: Cooling off strategy) trial found no difference in ischemic outcomes when Gp IIb/IIIa inhibitors were excluded and ARMYDA-2 (Antiplatelet therapy for reduction of myocardial damage during angioplasty) suggested higher doses of clopidogrel are more appropriate during PCI when Gp IIb/IIIa inhibitors are not utilized. This constellation of new trials forces reconsideration of current recommendations in regards to patient risk stratification, choice of antithrombotic therapy, doses, and timing. These new data will impact emerging guidelines and updates are currently in progress.     

氯吡格雷联合阿司匹林对ACS患者行PCI术的疗效及抗感染作用

目的 观察双倍剂量氯吡格雷联合阿司匹林在行经皮冠状动脉介入治疗(PCI)急性冠脉综合征(ACS)患者中的疗效和抗感染作用.方法 对于ACS患者PCI术后血栓并发症高危患者168例,随机分为3组,观察组使用双倍负荷量和双倍维持量(共2周)的氯吡格雷,3组患者术前每天均服用阿司匹林100 mg(＞1周),手术当天服用300 mg,术后给予100 mg维持;术后给予药物治疗,并观察术后30 d内心血管死亡、心肌梗死、心绞痛、脑卒中、休克等心血管事件和出血并发症的发生.结果 30 d内A组仪发生心血管事件2例(3.6％),为复发性缺血症和心肌梗死;与B、C组相比效果最著,差异有统计学意义(P＜0.05).结论 对于ACS患者PCI术后血栓并发症高危患者给予双倍剂量的氯吡格雷后,心血管事件和出血发生较少,术后无感染病例发生.     

血小板功能检测指导急性冠脉综合征抗血小板治疗的研究

目的探索血小板功能检测在未行血运重建术治疗的急性冠脉综合征(ACS)患者中抗血小板治疗的临床应用价值。方法 60例ACS患者根据血小板功能分为四组予相应的个体化抗血小板治疗,并随访1年,比较四组患者血栓/出血事件发生率。结果高剂量氯吡格雷治疗组及加用西洛他唑治疗组血小板聚集率比标准治疗组明显下降(P<0.05),但四组患者主要心血管事件发生率及出血率无统计学差异(P>0.05)。结论血小板功能检测在指导急性冠脉综合征患者抗血小板治疗中未获得预期临床获益,其应用价值仍需大规模、前瞻性及更严谨的研究去验证。     

三联抗血小板治疗急性ST段抬高型心肌梗死患者的临床效果研究

目的 探讨三联抗血小板治疗急性ST段抬高型心肌梗死(STEMI)患者的临床效果。方法 选取2019年1月至2021年1月我院收治的75例急性STEMI患者,随机分为对照组(n=38)和观察组(n=37)。两组患者均行急诊PCI治疗,对照组在PCI术后采用阿司匹林联合氯吡格雷治疗,观察组在PCI术后采用阿司匹林、替格瑞洛、替罗非班治疗。比较两组患者的心肌酶水平、不良反应及主要心血管不良事件(MACE)发生率。结果 治疗后,观察组的肌钙蛋白、肌酸激酶、肌酸激酶同工酶水平低于对照组(P<0.05)。观察组不良反应发生率为16.2%,与对照组的10.5%比较差异无统计学意义(P<0.05)。观察组的MACE发生率为2.7%,低于对照组的21.1%(P<0.05)。结论 阿司匹林、替格瑞洛、替罗非班三联抗血小板可减轻急性STEMI患者的心肌损伤,降低MACE发生风险,且用药安全性良好。     

血小板聚集率检测对行经皮冠脉介入术患者的临床意义探讨

目的研究血小板聚集率检测水平与行经皮冠脉介入（percutancous coronary intervention,PCI）术后患者心血管不良事件的相关性。方法用比浊法和阻抗法检测119例行PCI术服用阿司匹林和氯吡格雷超过7 d的患者的血浆或全血的血小板聚集率,促凝剂分别为终浓度为5μmo/lL的ADP或终浓度为2 mg/L的胶原。1年后随访,用SPSS13.0对未发生心血管不良事件及发生心血管不良事件组的患者的血小板聚集率平均值进行统计学分析。结果 13例发生心肌缺血等心血管不良事件组患者以ADP为促凝剂比浊法测定的血小板聚集率平均值（0.63±0.12）,与未发生心血管不良事件组患者的血小板聚集率平均值（0.48±0.18）比较,差异有统计学意义（P〈0.05）;两组患者以胶原为促凝剂阻抗法检测的血小板聚集率平均值（分别为8.3±3.8和5.2±3.3）比较,差异有统计学意义。两组患者以ADP为促凝剂阻抗法测定的血小板聚集率平均值,及以胶原为促凝剂比浊法检测的血小板聚集率平均值比较差异无统计学意义。结论以ADP为促凝剂比浊法,及以胶原为促凝剂阻抗法检测的血小板聚集率,与行PCI术常规服用阿司匹林和氯吡格雷抗血小板药的患者是否易发生心血管不良事件,有一定的相关性。     

基于随机森林算法的急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后无复流风险因素分析

目的采用随机森林算法探讨急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后无复流风险因素。方法回顾性分析2013年1月至2019年6月期间某院行直接PCI术的急性STEMI患者的临床资料。收集患者入院时的一般资料、相关检验指标以及PCI术后情况等。应用随机森林算法和多因素logistic回归分析对风险因素进行分析。结果收集352例符合纳入标准的行直接PCI术的急性STEMI患者,其中63例无复流,289例有复流。构建随机森林模型,使用C-index进行评估,训练集C-index为0.980,测试集C-index为0.840,模型预测效力尚可,筛选出变量平均血小板体积/淋巴细胞比率(MPVLR)、病变长度、高血压、发病到球囊扩张时间(PBT)、淋巴细胞计数(LYM)、血小板/淋巴细胞比率(PLR),进一步行多因素logistic回归表明MPVLR、高血压、PBT、LYM、PLR为影响急性STEMI患者直接PCI术后无复流的风险因素。结论通过随机森林分析筛选出了急性STEMI患者直接PCI术后无复流风险因素,结合logistic回归分析,MPVLR、高血压、PBT、LYM、PLR为影响急性STEMI患者直接PCI术后无复流的风险因素,可为医务人员快速简单地进行风险分析、及早干预提供依据。     

The cost-effectiveness of dual oral antiplatelet therapy following percutaneous coronary intervention: a Swedish analysis of the CREDO trial.

The CREDO trial demonstrated the clinical efficacy of 12-month antiplatelet therapy with clopidogrel compared to standard 28-day treatment with a 27% relative reduction in the combined risk of death, myocardial infarction, or stroke in patients undergoing percutaneous coronary intervention (PCI) and being treated with aspirin. This study evaluated the long-term cost-effectiveness of 12-month vs. 28-day therapy with clopidogrel in Sweden. A Markov model was developed which assumed a hypothetical cohort of patients in a post-PCI state to have certain risks of suffering one of the endpoints of the CREDO trial: stroke, myocardial infarction, or death. The model predicted a mean survival of 12.098 years in the 12-month arm vs. 12.026 in the 28-day arm, an incremental gain of 0.072 life-years. The gain in survival came at a predicted incremental cost of Euro 217, resulting in an incremental cost-effectiveness ratio of Euro 3,022. Thus the predicted cost-effectiveness ratio of long-term treatment with clopidogrel in patients undergoing PCI is well below the threshold values currently considered cost-effective.     

Bivalirudin in percutaneous coronary intervention

Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS). Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP) IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use ofbivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY) trial are discussed.     

急性前壁ST段抬高心肌梗死急诊经皮冠状动脉介入治疗后单导联ST段回落程度对预后的影响

目的探讨急性前壁sT段抬高心肌梗死（sTEMI）急诊经皮冠状动脉介入治疗（PCI）后单导联sT段回落程度对临床预后的影响,以早期识别高危患者,从而积极提高心肌组织的再灌注。方法回顾性分析42例急性前壁STEMI患者的临床资料,其中sT段回落良好组31例,sT段回落不良组11例,比较两组患者冠状动脉造影结果、治疗前后用药及住院期间主要不良心脏事件（MACE）发生的差异。结果sT段回落不良组糖尿病比例高于sT段回落良好组（10／11比7／31）,左室射血分数低于sT段回落良好组[（48．2±10．1）％比（54．6±9．7）％],差异均有统计学意义（尸〈0．05）。ST段回落不良组冠状动脉内明显血栓、术前TIMI血流0～1级、术后TIMI血流≤2级、MACE比例均高于sT段回落良好组,起病至球囊开通时间长于sT段回落良好组,差异均有统计学意义（P〈0．05）。结论急性前壁STEMI患者PCI术后单导联ST段回落程度可以预测MACE发生率,能识别PCI后的高危患者。     

抗血小板药物联合应用在冠心病患者中的可行性与安全性分析

目的：探讨氯吡格雷联合阿司匹林抗血小板治疗冠心病老年患者的可行性和安全性。方法：选取本院2012年1月-2013年6月收治的老年冠心病患者100例,按随机数字表法分为观察组和对照组,每组各50例。对照组给予阿司匹林;观察组给予氯吡格雷联合阿司匹林。观察两组的血小板计数、血小板聚集率、出血率及凝血三项。结果：治疗后,两组血小板计数和血小板聚集率较治疗前均明显降低（P〈0．05）,出血率与治疗前比较差异无统计学意义（P〉0．05）;两组间血小板计数、出血率比较,差异无统计学意义（P〉0．05）,但在治疗6个月和12个月时,观察组血小板聚集率疗效优于对照组（P〈0．05）;两组治疗前后及两组间的凝血三项比较变化均不明显。结论：采用氯吡格雷联合阿司匹林双联疗法疗效治疗老年冠心病患者临床疗效显著,安全可行。