经皮冠状动脉介入治疗早期增加氯吡格雷剂量对主要不良心血管事件的影响

目的 观察高危急性冠状动脉综合征(ACS)患者(包括不稳定性心绞痛、急性ST段抬高型心肌梗死和急性非ST段抬高型心肌梗死)经皮冠状动脉介入治疗(PCI)早期不同剂量氯吡格雷对主要不良心血管事件(MACE)的影响.方法 选择2008年1月至2011年6月因ACS行PCI术的患者共160例,所有患者按入院先后随机分为两组,一组为治疗组(80例),患者入院后阿司匹林300 mg顿服,后以100 mg qd,长期口服;氯吡格雷300 mg顿服,后以150 mg qd口服2周,2周后给予氯吡格雷75 mg qd至少1年;另一组为对照组(80例),患者入院后阿司匹林300 mg顿服,后以100 mg qd,长期口服,氯吡格雷75 mgqd至少1年.两组其余药物治疗均相同.分别于PCI术后1个月、6个月时观察MACE的影响.结果 两组患者临床基线特征基本一致,病变血管分布情况差异无统计学意义.两组患者PCI术后24 h、3d均未发生心脏不良事件,于术后1个月时,两组MACE的发生情况,治疗组低于对照组(6.2%vs.7.5%),但差异不具有统计学意义(P>0.05).而于术后6个月时,治疗组MACE的发生明显低于对照组(10.0%vs.17.5%),差异有统计学意义(P<0.05).结论 ACS患者在一般治疗的基础上,介入治疗时早期增加氯吡格雷的剂量可降低PCI术后MACE的发生率.

Effect of the treatment of early increase aspirin and clopidogrel dose on major adverse cardiovascular eventsin patients of acute coronary syndrome

Objective To observe the effects of different doses of aspirin to the major adverse cardiovascular events（MACE） of high risk patients with acute coronary syndrome （ACS） （including unstable angina, acute ST- segment elevation myocardial infarction and acute non-ST-segment elevation myocardial infarction）in the early stage after percutaneous coronary interention （PCI）. Methods From January 2008 to June 2011,160 ACS patients who undergone PCI were randomly divided into two groups according to admission. For patients in treatment group （ n = 80） ,300 mg of aspirin and 300 mg of clopidogrel were given at a draught after admission. After that, aspirin was orally taken at the dosage 100 mg qd on a long-term basis. Clopidogrel was orally given at 75 mg/day for a year after initial dosage of 150 mg/day for two week. For patients in control group（ n = 80） ,300 mg of aspirin was given at a draught after admission. After that, aspirin was orally given at 100 mg qd on a long-term basis. Meanwhile, Clopidogrel was orally administered at 75 mg qd for one year. Supplementary treatments for patients in both groups were given in the same way. The occurrence of MACE was compared at 1-month and 6-months after PCI, respectively. Results The baseline clinical characteristics in the two groups were basically identical and no statistically significant difference was observed for the distribution of vascular lesions. The incidence rate of MACE of treatment group was lower than control geoup 1 month after PCI,but the diffrernce was not statistically significant （6. 2% vs. 7. 5% ,P 〈 0. 05）. However,6-months after PCI, the difference of incidence rate of MACE was statistically significant （10. 0% vs. 17.5% ,P 〈 0.05）. Conclusions On the basis of general management, early increased dosage of clopidogrel for ACS patients undergoing PCI results in the reduction of the occurrence rate of MACE.