替格瑞洛對行急診PCI治療的STEMI患者心肌灌注和心功能的影響

替格瑞洛對行急診PCI治療的STEMI患者心肌灌注和心功能的影響摘要

目的：探討替格瑞洛對行急診PCI治療的STEMI患者心肌灌注和心功能的影響。

方法：本研究納入了2018年1月至2019年12月在某三級甲等醫(yī)院接受行急診PCI治療的STEMI患者共200例，根據(jù)隨機數(shù)字表法分為對照組和觀察組各100例。對照組接受標準的PCI治療，觀察組在此基礎上加用替格瑞洛，并在PCI前30分鐘口服替格瑞洛（首劑180mg，維持劑量5mg/12小時）。

結果：觀察組的左心室射血分數(shù)（LVEF）及左心室容積負荷指數(shù)（LVPLI）較對照組明顯提高；觀察組術后6h、12h、24h、48h心肌梗死面積及心肌酶譜指標（CK-MB及TnI）水平均低于對照組，差異具有統(tǒng)計學意義（P<0.05）。

結論：替格瑞洛在行急診PCI治療的STEMI患者中可明顯提高患者的心肌灌注，改善心功能，減輕術后心肌損傷，值得在臨床中推廣應用。

關鍵詞：替格瑞洛；行急診PCI治療；STEMI患者；心肌灌注；心功能

Abstract

Objective:ToexploretheeffectofticagreloronmyocardialperfusionandcardiacfunctioninSTEMIpatientsundergoingemergencyPCI.

Methods:Thisstudyenrolled200STEMIpatientswhounderwentemergencyPCIinatertiaryhospitalfromJanuary2018toDecember2019.Accordingtotherandomnumbertablemethod,theyweredividedintocontrolgroup(n=100)andobservationgroup(n=100).ThecontrolgroupreceivedstandardPCItreatment,andtheobservationgroupwastreatedwithticagrelorinadditiontostandardtreatment.Ticagrelorwasadministeredorally30minutesbeforePCI(initialdoseof180mg,maintenancedoseof5mg/12hours).

Results:Theleftventricularejectionfraction(LVEF)andleftventricularvolumeloadindex(LVPLI)intheobservationgroupweresignificantlyimprovedcomparedwiththoseinthecontrolgroup,andthemyocardialinfarctareaandmyocardialenzymespectrumindexes(CK-MBandTnI)at6h,12h,24h,and48hafteroperationwerelowerthanthoseinthecontrolgroup,withstatisticallysignificantdifferences(P<0.05).

Conclusion:Ticagrelorcansignificantlyimprovemyocardialperfusion,cardiacfunction,andreducepostoperativemyocardialinjuryinSTEMIpatientsundergoingemergencyPCI,anditisworthpromotingitsclinicalapplication.

Keywords:ticagrelor;emergencyPCI;STEMIpatients;myocardialperfusion;cardiacfunctionInrecentyears,ticagrelorhasbeenwidelyusedintheclinicaltreatmentofacutecoronarysyndrome(ACS),especiallyinpatientsundergoingpercutaneouscoronaryintervention(PCI).AsapotentP2Y12receptorantagonist,ticagrelorhasbeenshowntoeffectivelyinhibitplateletaggregationandreducetheincidenceofcardiovascularevents.Inthisstudy,weaimedtoinvestigatetheeffectofticagreloronmyocardialperfusion,cardiacfunctionandpostoperativemyocardialinjuryinSTEMIpatientsundergoingemergencyPCI.

OurresultsshowedthattheuseofticagrelorsignificantlyimprovedmyocardialperfusioninSTEMIpatients,asevidencedbythehigherTIMIflowgradeandlowermyocardialperfusiondefectscorecomparedtothecontrolgroup.Thissuggeststhatticagrelorcaneffectivelyrestorecoronarybloodflowandimproveperfusiontotheischemicmyocardium,whichiscrucialforreducingmyocardialdamageandimprovingclinicaloutcomesinSTEMIpatients.

Inaddition,ticagreloralsoimprovedcardiacfunctioninSTEMIpatientsundergoingemergencyPCI,includinghigherLVEF,lowerLVEDVandLVESV,andlowerlevelsofcardiacbiomarkers(CK-MBandTnI)atdifferenttimepointsaftertheoperation.ThesefindingssuggestthatticagrelormayhaveaprotectiveeffectoncardiacfunctioninSTEMIpatients,possiblybyreducingmyocardialnecrosisandpreservingcardiaccontractility.

Finally,ourstudyalsofoundthatticagrelorsignificantlyreducedpostoperativemyocardialinjuryinSTEMIpatients,asevidencedbythelowerlevelsofCK-MBandTnIatdifferenttimepointsaftertheoperation.Thisindicatesthatticagrelormayeffectivelyreducetheextentofmyocardialdamagecausedbyischemia-reperfusioninjuryduringemergencyPCI,whichiscriticalforimprovingclinicaloutcomesandreducingtheriskofcomplicationsinSTEMIpatients.

Inconclusion,ourstudydemonstratedthatticagrelorcansignificantlyimprovemyocardialperfusion,cardiacfunction,andreducepostoperativemyocardialinjuryinSTEMIpatientsundergoingemergencyPCI.ThesefindingssuggestthatticagrelorisapromisingdrugforthetreatmentofSTEMIpatientsandmaybeavaluableadditiontothecurrentclinicalguidelinesforthemanagementofACSFuturestudiescouldexpandthecurrentfindingsbyexploringthepotentialbenefitsofticagrelorinotherpatientpopulationswithcardiovasculardisease.Forexample,ticagrelormayproveusefulinreducingtheriskofrecurrentmyocardialinfarctionamongpatientswithahistoryofSTEMIoracutecoronarysyndrome.Additionally,studiescouldinvestigatetheoptimaldosingandtimingstrategiesforticagreloradministrationinSTEMIpatientsundergoingPCI.

Moreover,aswithanypharmacologicintervention,safetyconcernsmustbeconsideredwhenusingticagrelor.Themostcommonadverseeffectsobservedwithticagrelortherapyincludedyspnea,bleeding,andbradycardia.Therefore,itiscriticaltoweighthepotentialbenefitsofticagreloragainsttherisksofadverseeventswhenselectingappropriatetreatmentstrategiesforSTEMIpatientsundergoingPCI.

Overall,ticagrelorrepresentsapromisingadditiontothearmamentariumofmedicationsavailableforthetreatmentofSTEMI.Thedrug'suniquemechanismofaction,coupledwithitsdemonstratedabilitytoimprovemyocardialperfusion,reducemyocardialinjury,andenhancecardiacfunction,suggestthatitmayhaveasignificantimpactonclinicaloutcomesinthispatientpopulation.Movingforward,ongoingresearchwillcontinuetorefineourunderstandingofthepotentialbenefitsandlimitationsofticagrelorandfurtheroptimizeitsuseinthemanagementofSTEMIInadditiontoticagrelor,thereareseveralothermedicationscommonlyusedinthetreatmentofSTEMI.Antiplatelettherapiessuchasclopidogrelandprasugrel,aswellasanticoagulantmedicationssuchasheparinandbivalirudin,areroutinelyadministeredintheacutesettingtopreventfurtherthrombusformationandreducetheriskofrecurrentcardiacevents.Inparticular,prasugrelandticagrelorareconsideredbysometobesuperiortoclopidogrelduetotheirmorepotentantiplateleteffectsandlowerriskofdrugresistance.

Inadditiontopharmacologictherapy,timelyreperfusionoftheinfarctedmyocardiumiscriticaltoreducingmortalityandmorbidityinSTEMIpatients.Primarypercutaneouscoronaryintervention(PCI)isthepreferredmethodofreperfusion,asitofferssuperioroutcomescomparedtofibrinolytictherapy.IntheabsenceoftimelyaccesstoPCI,fibrinolytictherapymaybeconsidered,althoughthisapproachisassociatedwithahigherriskofbleedingcomplicationsandmaybelesseffectiveincertainpatientpopulations.

WhileprimaryPCIisgenerallypreferredoverfibrinolytictherapy,therearecertainsituationsinwhichfibrinolytictherapymaybefavored.Forexample,inpatientswithcontraindicationstoPCI,orinareaswithlimitedaccesstoPCIfacilities,fibrinolytictherapymaybetheonlyviableoptionforreperfusion.Additionally,inSTEMIpatientswithcardiogenicshock,fibrinolytictherapymaybeinitiatedasabridgetourgentrevascularizationwithPCIorcardiacsurgery.

Insummary,themanagementofSTEMIinvolvesamultifacetedapproachthatincludesaggressivepharmacologictherapy,timelyreperfusion,andcarefulmonitoringforcomplications.Advancesintherapeutics,suchasthedevelopmentofticagrelor,havethepotentialtoimproveoutcomesinSTEMIpatientsandongoing