2020 年第 8 期 第 15 卷

替格瑞洛用于经皮冠状动脉介入治疗高SYNTAX评分患者中的主要不良心血管事件发生率和安全性分析

Analysis of the incidence and safety of major adverse cardiovascular events in ticagrelor for percutaneous coronary intervention in patients with high SYNTAX score

作者：陶英张京梅高玉龙林运王苏李志忠

英文作者：Tao Ying Zhang Jingmei Gao Yulong Lin Yun Wang Su Li Zhizhong

单位：首都医科大学附属北京安贞医院心内科100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：经皮冠状动脉介入；替格瑞洛；SYNTAX评分；主要不良心血管事件

英文关键词：Percutaneouscoronaryintervention;Ticagrelor;SYNTAXscore;Majoradversecardiovascularevents

• 摘要：

• 目的 比较替格瑞洛和氯吡格雷在行经皮冠状动脉介入（PCI）的高SYNTAX评分患者中的治疗效果。方法 选取2016年1月至2019年5月于首都医科大学附属北京安贞医院住院并进行PCI治疗的患者2 157例，均为SYNTAX总分≥23分，完全随机分为2组，PCI术后分别使用替格瑞洛联合阿司匹林（1 075例，替格瑞洛组），氯吡格雷联合阿司匹林（1 082例，氯吡格雷组）进行抗血小板治疗。随访12个月，比较2组患者的主要不良心血管事件（MACE）和出血事件发生情况，对出血事件进行PLATO分级。结果 2组患者的基本资料、PCI手术相关参数和SYNTAX评分差异均无统计学意义（均P＞0.05）。替格瑞洛组的主要终点事件（血管原因死亡、心肌梗死或卒中)明显少于氯吡格雷组［2.6%(28/1 075)比4.2%(45/1 082)］（P＜0.05）；而对于次要终点事件，替格瑞洛组的心肌梗死和支架内血栓发生率明显低于氯吡格雷组［2.1%（23/1 075）比3.8%（41/1 082），0.5%（5/1 075）比1.6%（17/1 082），均P＜0.05］，而全因死亡，心血管死亡及卒中发生率差异无统计学意义（P＞0.05）。替格瑞洛组的总体出血事件发生率明显高于氯吡格雷组［15.3%（165/1 075）比10.7%（116/1 082）］（P＜0.01）。结论 在行PCI治疗的高SYNTAX评分患者中，与氯吡格雷相比，使用替格瑞洛治疗可明显降低MACE发生率，同时不增加主要和次要出血事件的发生率。替格瑞洛治疗复杂病变患者具有较好的临床疗效和安全性。

• Objective To compare the therapeutic effect of ticagrelor and clopidogrel in patients with high SYNTAX score undergoing percutaneous coronary intervention (PCI).  Methods A total of 2 157  PCI patients （all SYNTAX≥23）admitted to Beijing Anzhen Hospital， Capital Medical University from January 2016 to May 2019 were selected. All patients were randomly divided into the ticagrelor group (1 075 cases) and the clopidogrel group (1 082 cases). The ticagrelor group was treated with ticagrelor and aspirin after PCI, and the clopidogrel group was treated with clopidogrel and aspirin. During the 12-month follow-up, the occurrence of major adverse cardiovascular events(MACE) and bleeding events was compared between two groups, and the bleeding events were graded by PLATO. Results There was no significant difference in the basic data, PCI-related parameters and SYNTAX scores between the two groups of patients（all P＞0.05）. The incidence of primary end-point event (vascular death, myocardial infarction, or stroke) in the ticagrelor group was significantly less than that in the clopidogrel group ［2.6%(28/1 075) vs 4.2%(45/1 082)，P＜0.05］. For secondary end-point events, the incidence of myocardial infarction and stent thrombosis in the ticagrelor group was significantly lower than that in the clopidogrel group ［2.1% (23/1 075) vs 3.8% (41/1 082), 0.5% (5/ 1 075) vs 1.6% (17/1 082), all P<0.05］, but there was no statistically significant difference in the incidence of all-cause death, cardiovascular death and stroke (P>0.05). The overall incidence of bleeding events in the ticagrelor group was significantly higher than that in the clopidogrel group ［15.3% (165/1 075) vs 10.7% (116/1 082)，P<0.01］. Conclusions In patients with high SYNTAX scores treated with PCI, the use of ticagrelor significantly reduced the incidence of MACE compared with clopidogrel, while not increasing the incidence of major and minor bleeding events. Tigrelol has better clinical efficacy and safety in the treatment of patients with complex lesions.