氯吡格雷联合阿司匹林对ACS患者行PCI术的50例疗效观察

目的分析双倍剂量氯吡格雷联合阿司匹林与常规剂量氯吡格雷对急性冠状动脉综合症（ACS）患者行经皮冠状动脉介入治疗（PCI）术后的临床疗效和安全性。方法选择我院2010年2月-2012年2月确诊为ACS择期行PCI术的患者50例作为研究对象,随机分为双倍剂量组（A组）和常规剂量组（B组）各25例,两组患者均于术前1周服用阿司匹林100mg／d,手术当天服用300mg,术后给予100mg维持;手术前6h给予氯吡格雷,A组600mg,B组300mg,手术后均在服用阿司匹林基础上给予氯吡格雷150mg／d治疗30d,75mg／d维持治疗直至术后1a。随访记录PCI术后30d内不良反应应发生情况。结果A组30d内未观察到心血管不良事件的发生,B组心血管不良事件发生率为8．0％,差异无统计学意义（x2=2．084,P=0．149）。A组30d内出血事件发生率为36．0％,略高于常规剂量组的24．0％,且仅在双倍剂量组出现1例消化道出血,其余均为次要出血事件,经）（2检验,两组差异无统计学意义（x2=0．857,P=0．355）。结论双倍剂量的氯吡格雷联合阿司匹林对ACS患者PCI术的治疗安全、有效,但对远期预后和不良事件发生率的影响还有待进一步的研究。     

急性冠脉综合征介入治疗术后出现氯吡格雷抵抗的护理

目的通过观察氯吡格雷在急性冠脉综合征冠状动脉介入术后的作用与益处,以及临床心血管血栓事件,探讨产生氯吡格雷抵抗的原因,为医生提供研究氯吡格雷抵抗的预防、治疗及早期识别的临床资料,总结该类病例的护理措施,从而减少恶性心血管事件发生。方法对临床120例急性冠脉综合征冠状动脉介入术后患者使用氯吡格雷300 mg的患者进行用药观察。入选120例拟行经皮冠状动脉介入治疗(PCI)的ACS患者,服用负荷量氯吡格雷(CPG)前、服药24 h后采血,利用光比浊法测定血浆二磷酸腺苷(ADP)诱导的血小板聚集率(PA),根据PA抑制程度判断CPGR发生率,并根据此分为氯吡格雷抵抗CPGR组和非CPGR组,对发生CPGR组患者进行密切观察,实施临床护理。结果 120例ACS患者中有31例发生CPGR,发生率为25.8%,护士能够针对发生CPGR的原因提供整体护理措施。结论 ACS和PCI术后抗血小板治疗中,部分患者确实存在CPGR现象,PA水平对CPGR具有重要的预测价值,同时能指导临床整体护理措施的实施。     

负荷剂量氢氯格雷联合大剂量阿托伐他汀治疗进展性脑梗死的有效性

目的探索负荷剂量氢氯格雷联合大剂量阿托伐他汀治疗进展性脑梗死的有效性及安全性。方法80例进展性脑梗死患者随机分为治疗组和对照组,治疗组应用负荷剂量氯吡格雷联合大剂量阿托伐他汀治疗(第1天口服氯吡格雷300 mg,以后每天口服75 mg,同时口服阿托伐他汀40 mg/d),对照组给予口服氯吡格雷75 mg/d、阿托伐他汀20 mg/d,两组连用14天,治疗前、治疗72 h、7 d、14 d,分别进行NIHSS评分和Barthel指数评定。结果治疗组及观察组均未出现严重的不良反应,治疗后72 h、7 d、14 d治疗组的NIHSS评分明显低于对照组(P<0.05),BI显著高于对照组(P<0.05)。结论应用负荷剂量氢氯格雷联合大剂量阿托伐他汀能有效的治疗进展性脑梗死,改善预后,不良反应小。     

CYP2C19基因多态性对氯吡格雷抗血小板作用的影响

目的研究不同CYP2C19基因分型对急性冠脉综合征患者氯吡格雷抗血小板效能的影响。方法入选2015年1月-2016年1月在中山大学附属第三医院诊断为急性冠脉综合征患者301例,入院时抽血检测CYP2C19基因多态性,按基因型分为快代谢型、中等代谢型和慢代谢型3组。入院当天给予拜阿司匹林标准剂量和负荷量氯吡格雷300 mg,之后常规剂量氯吡格雷75 mg/d。分别于入院第1 d和第7 d测血浆二磷酸腺苷(ADP浓度)诱导的血小板聚集率。结果服用氯吡格雷前,3组间血小板聚集率比较差异无统计学意义。服用氯吡格雷7 d后,3组血小板聚集率较服药前下降,差异均有统计学意义(P0.05)。结论对于急性冠脉综合征患者,及时检测CYP2C19基因多态性对指导临床上抗血小板药物的治疗具有重要意义。     

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.     

大剂量氯吡格雷在冠心病介入治疗中的应用

目的探讨大剂量氯吡格雷在冠心病介入治疗中的效果及安全性。方法选取2010年5月—2012年4月行冠心病介入治疗的患者124例,依患者意愿随机分为观察组64例和对照组60例,两组治疗前均依据年龄、病程、心功能状态及有无并发症等进行综合危险度评估,确保样本患者均符合试验条件。观察组术前7 d口服阿司匹林100 mg/d,并在行冠心病介入治疗前6 h分别给予阿司匹林300 mg/d和氯吡格雷600 mg/d口服。术后次日再口服阿司匹林300 mg/d和氯吡格雷150 mg/d,1个月后改为100 mg/d和75 mg/d,持续皮下注射低分子肝素7 d。同时依据患者情况给予β受体阻滞剂、硝酸酯类和他汀类降脂药等辅助治疗。对照组仅将氯吡格雷换成噻氯匹定,使用方法同观察组。分别于术前、服药12、24 h后检测两组血小板聚集率及术后并发症情况。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果服药后12、24 h血小板聚集率观察组分别为(31.0±5.2)%、(27.3±1.8)%,对照组分别为(36.4±2.6)%、(31.4±3.0)%,比较差异均有统计学意义(t=7.239、9.295,均P<0.05)。不良反应发生率观察组3.1%,对照组6.7%,两组比较差异无统计学意义(χ2=0.250,P>0.05)。结论大剂量氯吡格雷对减少冠心病介入治疗中血栓形成疗效确切,临床不良反应小,可推广应用。     

不同负荷剂量氯吡格雷对急性心肌梗死合并2型糖尿病患者血小板功能及PCI治疗术后心肌灌注的影响

目的 探讨不同负荷剂量氯吡格雷对急性心肌梗死(AMI)合并2型糖尿病(T2DM)患者血小板功能及经皮冠状动脉介入(PCI)治疗术后心肌灌注的影响.方法 52例初诊的AMI合并T2DM患者,随机分为超负荷剂量组(24例,氯吡格雷600 mg)和常规负荷剂量组(28例,氯吡格雷300 mg).测定两组最大血小板聚集率(MPAR)变化情况;行PCI治疗后,术后即刻对病变血管行心肌呈色分级(MBG),评价心肌微循环灌注情况.结果 两组患者一般情况比较差异均无统计学意义(P＞0.05).MPAR术前两组比较差异无统计学意义,术后90 min、术后24 h,超负荷剂量组MPAR明显低于常规负荷剂量组;术后MBG 3级获得率超负荷剂量组明显高于常规负荷剂量组(79.2%比32.1%,P＜0.01).出血并发症两组比较差异无统计学意义.结论 超负荷剂量氯吡格雷可以更有效、更迅速地抑制AMI合并T2DM患者MPAR,改善心肌灌注,且安全可行.     

比较不同剂量氯吡格雷用于急性ST段抬高心肌梗死的疗效

目的：通过氯吡格雷治疗急性sT段抬高心肌梗死,探讨使用不同剂量氯吡格雷的临床效果。方法：本院共接收急性sT段抬高心肌梗死患者116例,将患者分为观察组和对照组。观察组58例,治疗前服用氯吡格雷600mg,之后每日服用氯吡格雷75mg作为维持剂量;对照组58例,治疗前服用氯吡格雷300mg,之后每日服用氯吡格雷75mg作为维持剂量。结果：经治疗后,观察组显效54例,治疗总有效率为93．1％;对照组显效42例,总有效率为72．4％。结论：起始服用氯吡格雷600mg治疗急性sT段抬高心肌梗死,其治疗总有效率要高于起始服用氯吡格雷300mg,且安全性良好。     

个体化基因指导的氯吡格雷对冠心病患者介入治疗 术后主要心血管事件的影响

目的探讨细胞色素P450基因超家族2C19(CYP2C19)基因型指导的氯吡格雷对于冠心病患者经皮冠状动脉介入(PCI)术后12个月主要不良心血管事件(major adverse cardiac events,MACE)的干预效果。方法选择2015年9月～2016年9月解放军总医院第一医学中心老年心血管研究所行PCI的冠心病患者277例,随机分为氯吡格雷组138例和替格瑞洛组139例。氯吡格雷组行CYP2C19基因型检测。快、中代谢型患者给予维持剂量75 mg/d,慢代谢型患者给予高剂量维持剂量150 mg/d,服用3个月后更改为75 mg/d;替格瑞洛组给予180 mg负荷剂量和90 mg,2次/d的维持剂量,所有PCI患者双联抗血小板12个月并随访12个月内的临床终点事件。结果替格瑞洛组球囊预扩张压力明显低于氯吡格雷组,差异有统计学意义[(11.4±1.8)%vs.(12.2±2.7)%,P 0.01)。2组心源性死亡、靶血管再次血运重建率、支架内血栓、再次反复发作心绞痛比较,差异无统计学意义(P 0.05)。氯吡格雷组胸痛再次入院和MACE发生率较替格瑞洛组明显升高差异有统计学意义(4.3%vs.0,P=0.014;13.0%vs. 5.8%,P=0.041)。结论替格瑞洛较CYP2C19指导的氯吡格雷维持剂量可能会取得更优的临床效果。     

老年急性冠脉综合征患者介入治疗后应用高维持剂量氯吡格雷的安全性

目的 研究老年急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后应用高维持剂量氯吡格雷的安全性.方法 选取96例老年ACS患者,PCI术后按TIMI危险积分,采用机械抽样法随机分为两组,在PCI术后分别给予氯吡格雷150 mg/d(高维持剂量组,47例)和75mg/d(常规剂量组,49例),均口服给药,3个月后两组均给予75 mg/d,直至术后1年.其他常规治疗不变.比较两组术后30 d、6个月时主要不良心脏事件(MACE)及术后出血并发症的发生率.结果 常规剂量组和高维持剂量组患者术后30 d、6个月时MACE发生率[4.08%(2/49)比4.26%(2/47),6.12%(3/49)比8.51%(4/47)]以及术后出血并发症发生率[严重:2.04%(1/49)比4.26%(2/47),轻微:8.16%(4/49)比8.51%(4/47)]比较差异均无统计学意义(P>0.05).结论 老年ACS患者PCI术后应用高维持剂量氯吡格雷(150 mg/d)是安全的.     

Clinical impact of enhanced inhibition of P2Y12-mediated platelet aggregation in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

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.     

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.     

不同剂量氯吡格雷在冠状动脉支架术后的有效性及安全性临床观察

目的：探讨在冠状动脉支架术后最具有安全性及有效性的氯吡格雷剂量。方法：选取2011年1月-2013年1月本院收治的行冠状动脉支架术的120例患者,按照随机数字表法将其分为对照组和观察组各60例,观察组服用氯吡格雷600mg,对照组服用氯吡格雷300mg,维持一周,之后两组患者每日均服用氯吡格雷75mg作为维持剂量,持续一个月,观察比较两组患者的有效性及安全性。结果：观察组的临床治疗总有效率93．3％明显高于对照组的71．7％,差异有统计学意义（P〈0．05）;两组治疗后肌钙蛋白水平均明显下降,但观察组下降更为明显,且观察组的心血管不良反应发生率6．67％明显低于对照组的20．0％,差异均有统计学意义（P〈0．05）。结论：与使用氯吡格雷的起始剂量为300mg相比,起始剂量为600mg时临床疗效显著,可有效降低患者的肌钙蛋白水平及心血管不良反应的发生,具有安全性及有效性,是防止冠状动脉支架术后引发再次狭窄的有效药物,值得临床推广应用。     

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.     

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。     

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。     

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.     

氯吡格雷在冠心病介入治疗后的应用价值

目的 探讨氯吡格雷在冠心病介入治疗后的应用方法及效果.方法 选取2019年10月—2020年12月医院收治的81例冠心病经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)治疗患者作为样本对象,随机数字表法分为两组.术后对照组(n=40)采用阿司匹林肠溶片治疗,观察组(n...     

急性心肌梗死急诊介入治疗中替罗非班冠状动脉内注入对疗效的影响

目的 观察急性心肌梗死患者急诊经皮冠状动脉介入治疗(PCI)术中冠状动脉内应用替罗非班的临床疗效.方法 76例急性心肌梗死患者随机分为替罗非班组(39例)和对照组(37例),均于发病12h内行急诊PCI.替罗非班组PCI术中冠状动脉内注入替罗非班,并静脉维持48h.术后应用达肝素钠注射液.对照组PCI术中仅给予普通肝素.两组PCI术前均服用氯吡格雷、阿司匹林.观察PCI术前、术后梗死相关血管心肌梗死时溶栓(TIMI)血流、心肌灌注分级(TMPG)、术后2周内并发症及主要心脏不良事件的发生情况.结果 替罗非班组PCI术后TIMI 3级占94.9%(37/39),高于对照组的78.4%(29/37),替罗非班组TMPG 3级占89.7%(35/39),高于对照组的67.6%(25/37),两组比较差异均有统计学意义(P值均<0.05).替罗非班组主要心脏不良事件的发生率7.7%(3/39)低于对照组的18.9%(7/37)(P<0.05),出血发生率与对照组比较差异无统计学意义(P>0.05).结论 PCI术中冠状动脉内应用替罗非班能改善急性心肌梗死患者梗死心肌的再灌注,减少术后主要心脏不良事件的发生率,且安全性好.