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目的:观察替格瑞洛对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)治疗后心肌组织灌注的影响及安全性。方法:确诊急性STEMI并接受急诊PCI治疗患者174例,随机分为替格瑞洛组86例和氯吡格雷组88例。比较两组术后即刻TIMI心肌灌注分级(TMPG)、术后2h心电图ST段回落百分比(sumSTR),以评估其心肌组织灌注水平;术后1周进行心脏彩超检查,比较两组左心室射血分数(LVEF);随访30天,比较两组主要不良心血管事件(MACE)及出血事件的发生情况。结果:(1)替格瑞洛组PCI术后即刻TMPG 3级获得率、术后2h心电图ST段完全回落比例、术后7天LVEF均显著或非常显著高于氯吡格雷组(P<0.05,P<0.01);(2)随访30天,替格瑞洛组MACE发生率显著低于氯吡格雷组(P<0.05),两组出血事件发生率差异不显著(P>0.05)。结论:替格瑞洛用于急性STEMI患者急诊PCI围术期可改善心肌组织灌注水平,减少MACE的发生,且不增加出血率。
Objective: To observe the effect and safety of ticagrelor on myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods: A total of 174 patients with acute STEMI who underwent emergency PCI were randomly divided into ticagrelor group (n = 86) and clopidogrel group (n = 88). The myocardial TIMP myocardial perfusion grade (TMPG), STSTR fall percentage (sumSTR) at 2h postoperatively were compared between two groups to evaluate the perfusion of myocardial tissue. One week after operation, the echocardiography was performed. The left ventricular ejection fraction Score (LVEF). Followed up for 30 days, the incidence of major adverse cardiovascular events (MACE) and bleeding events were compared between the two groups. Results: (1) The TMPG grade 3 acquisition rate, the complete regression rate of ST segment 2 hours after PCI in Ticagrelor group were significantly higher than those in Clopidogrel group (P <0.05) , P <0.01). (2) After 30 days of follow-up, the incidence of MACE in ticagrelor group was significantly lower than that in clopidogrel group (P <0.05). There was no significant difference in the incidence of bleeding between the two groups (P> 0.05). CONCLUSION: Ticagrelor can be used in patients with acute STEMI for acute perioperative PCI to improve myocardial perfusion, reduce the incidence of MACE, and not increase the bleeding rate.