替格瑞洛在ST段抬高型心肌梗死溶栓失败患者中应用的安全性和可行性

目的 探讨替格瑞洛在ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）溶栓失败患者中应用的安全性和可行性。 方法 连续入选2018年1月至2019年12月就诊于河北医科大学第二医院胸痛中心的STEMI溶栓失败患者。所有入选患者在急诊介入治疗后随机分为氯吡格雷组（n=32）和替格瑞洛组（n=33），分别给予氯吡格雷75 mg，1次/d和替格瑞洛90 mg，2次/d口服。比较治疗前和治疗后（5~7）d两组患者血小板聚集率（platelet aggregation rate，PAR）和超敏C反应蛋白（hs-CRP）的变化。比较两组患者住院期间主要心脏不良事件（major adverse cardiac events，MACE）的发生情况。 结果 两组患者基线临床资料和介入相关资料均无明显差异。与氯吡格雷组相比，替格瑞洛组患者肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）水平均较低（P < 0.05，P < 0.01）。两组患者均于介入术后24 h内行超声心动图检查，替格瑞洛组患者左室舒张末内径（LVEDD）有减少趋势，左心室射血分数（LVEF）无明显差异。Logistic回归分析结果显示，糖尿病与溶栓后补救性介入治疗的STEMI患者住院期间出血事件的发生相关。 结论 对于溶栓失败的STEMI患者，补救性冠脉介入治疗后应用替格瑞洛抗血小板治疗安全可行。

Safety and feasibility of ticagrelor after failed thrombolysis in patients with ST-segment elevation myocardial infarction

AIM To explore the safety and feasibility of ticagrelor after failed thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI). METHODS Patients with STEMI who were failed in the thrombolytic treatment were continuously enrolled in the chest pain center of the Second Hospital of Hebei Medical University from January 2018 to December 2019. All patients were randomly divided into the clopidogrel group and the ticagrelor group after emergency intervention treatment, and were given oral clopidogrel 75 mg, 1 /d and ticagrelor 90 mg, 2 / d. Changes in platelet aggregation rate (PAR) and high-sensitivity C-reactive protein (hs-CRP) were compared between the two groups before and (5-7) days after treatment. The incidence of major adverse cardiac events (MACE) during the hospitalization of the two groups was compared. RESULTS The patients were randomly divided into the clopidogrel group (n = 32) and the ticagrelor group (n = 33). There were no significant differences in baseline data between the two groups. Compared with the clopidogrel group, the levels of CK, CK-MB, and cTnI in the ticagrelor group were lower (P < 0.05, P < 0.01). The left ventricular end-diastolic diameter (LVEDD) of the ticagrelor group had a decreasing trend, and there was no significant difference in left ventricular ejection fraction (LVEF). Logistic regression analysis showed that diabetes was related to the occurrence of bleeding events during hospitalization in STEMI patients who received rescue intervention after failed thrombolysis. CONCLUSION For patients with STEMI who have failed thrombolysis, the use of ticagrelor therapy after rescue coronary intervention is safe and feasible.