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目的 分析替格瑞洛和氯吡格雷对急性冠脉综合征（ACS）患者择期经皮冠状动脉介入（PCI）治疗的有效性及安全性。方法 诊断为ACS并择期行PCI术的患者1 159例随访1年，依患者服用双重抗血小板药物不同分为替格瑞洛组(n=312)和氯吡格雷组(n=847)，其中3例在随访过程中排除，27例失访，最终纳入1 129例，替格瑞洛组(n=303)和氯吡格雷组(n=826)。比较两组患者基线资料的差异及主要心血管不良事件（MACE，包含心血管死亡、心肌梗死、缺血性卒中）和大出血事件（美国出血学术研究会制定的出血分级标准中Ⅱ型、Ⅲ型及Ⅴ型出血）的发生率。结果 替格瑞洛组患者肌钙蛋白I（TnI）偏高，左室射血分数（LVEF）值偏低，植入支架数多，最大狭窄率高，复杂病变比例高，桡动脉入路少，分次PCI比例高（均P<0.05）。替格瑞洛组发生MACE事件（15.2%）与氯吡格雷组（12.6%）相比〔危险比(hazard ratio,HR)=1.226，95%可信区间0.867~1.735，P=0.249〕及大出血事件替格瑞洛组（0.7%）与氯吡格雷组（0.7%）相比（HR=1.093，95%可信区间0.212~5.634，P=1），差异均无统计学意义。单因素分析影响预后的因素包括：男性、城市来源、LVEF、分次PCI是保护性因素；高脂血症、脑梗病史、病变血管数目、安放支架数目、最大狭窄率、醛固酮受体拮抗剂是危险性因素，利用可能影响患者预后的因素作为因子多元逐步Cox比例风险回归模型模型分析结果是替格瑞洛与氯吡格雷HR=1.118，95%可信区间0.755~1.656，P>0.05。结论 替格瑞洛和氯吡格雷用于ACS择期PCI术后患者的疗效和安全性相当。
Objective To analyze the efficacy and safety of ticagrelor and clopidogrel for elective percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods A total of 1 159 patients with ACS diagnosed as PCI undergoing elective PCI were followed up for 1 year. Patients were divided into ticagrelor group (n = 312) and clopidogrel group (n = 847) according to the patients taking dual antiplatelet drugs. Among them, Three were excluded during follow-up, and 27 were lost to follow-up, eventually enrolling 1 129 patients in the ticagrelor group (n = 303) and clopidogrel group (n = 826). Differences in baseline data and major cardiovascular adverse events (MACE, including cardiovascular death, myocardial infarction, ischemic stroke) and major bleeding events were compared between the two groups (type II, type III And Ⅴ type bleeding) incidence. Results Ticlofiben group had higher TnI, lower left ventricular ejection fraction (LVEF), more stent implantation, higher maximum stenosis rate, higher proportion of complicated lesions and less radial artery approach , With a high proportion of graded PCI (all P & lt; 0.05). (Hazard ratio (HR) = 1.226, 95% confidence interval 0.867 to 1.735, P = 0.249] and major bleeding in the ticagrelor group (15.2% vs clopidogrel group (12.6% There was no significant difference in the ticagrelor group (0.7%) vs. clopidogrel group (0.7%) (HR 1.093, 95% confidence interval 0.212-5.634, P = 1). Univariate analysis of prognostic factors include: male, urban source, LVEF, fractionated PCI is a protective factor; hyperlipidemia, history of cerebral infarction, the number of vascular lesions, the number of stent placement, the maximum stenosis rate, aldosterone receptor antagonist Is a risk factor and uses factors that may affect the patient’s prognosis as factors in multiple step-by-step Cox proportional hazards regression model. The model analysis showed ticagrelor versus clopidogrel HR = 1.118, 95% confidence interval 0.755 to 1.656, P> 0.05. Conclusion The efficacy and safety of ticagrelor and clopidogrel in patients undergoing elective PCI are comparable.