替格瑞洛对行急诊PCI治疗的STEMI患者心肌灌注和心功能的影响

替格瑞洛对行急诊PCI治疗的STEMI患者心肌灌注和心功能的影响摘要

目的：探讨替格瑞洛对行急诊PCI治疗的STEMI患者心肌灌注和心功能的影响。

方法：本研究纳入了2018年1月至2019年12月在某三级甲等医院接受行急诊PCI治疗的STEMI患者共200例，根据随机数字表法分为对照组和观察组各100例。对照组接受标准的PCI治疗，观察组在此基础上加用替格瑞洛，并在PCI前30分钟口服替格瑞洛（首剂180mg，维持剂量5mg/12小时）。

结果：观察组的左心室射血分数（LVEF）及左心室容积负荷指数（LVPLI）较对照组明显提高；观察组术后6h、12h、24h、48h心肌梗死面积及心肌酶谱指标（CK-MB及TnI）水平均低于对照组，差异具有统计学意义（P<0.05）。

结论：替格瑞洛在行急诊PCI治疗的STEMI患者中可明显提高患者的心肌灌注，改善心功能，减轻术后心肌损伤，值得在临床中推广应用。

关键词：替格瑞洛；行急诊PCI治疗；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