摘要
目的观察常规溶栓联合氯吡格雷治疗急性ST段抬高心肌梗死(STEMI)患者的近期疗效和安全性。方法回顾分析2004年1月至2006年12月沈阳军区总医院心内科接受常规溶栓治疗STEMI患者共158例的临床资料,其中联合氯吡格雷治疗者(氯吡格雷组)84例,男66例(78.6%),女18例(21.4%),老年(≥60岁)45例(53.6%);未联合氯吡格雷治疗者(对照组)74例,其中男58例(78.4%),女16例(21.6%),老年40例(54.1%)。比较两组间临床特征、溶栓血管再通率、30d主要不良心脏事件(MACE)、心绞痛复发及出血发生率。同时评价老年患者溶栓联合氯吡格雷治疗的疗效和安全性。结果两组临床特征差异无显著性意义(P>0.05),氯吡格雷组较对照组具有较高的血管再通率(69.1%对51.4%,P=0.035),较低的心源性死亡(0对6.8%,P=0.047)和MACE发生率(2.4%对12.2%,P=0.036),心绞痛复发、轻微及严重出血发生率与对照组比较差异无显著性意义(3.6%对2.7%,P=0.885;7.1%对9.5%,P=0.811;1.2%对1.4%,P=0.533)。老年患者氯吡格雷组血管再通率高于对照组,余指标差异无显著性意义,MACE发生率有下降的趋势(2.2%对12.5%,P=0.155)。氯吡格雷组内老年与非老年患者各项观察指标差异均无显著性意义。结论溶栓联合氯吡格雷治疗无论对老年还是非老年STEMI患者都是安全有效的。
Objective To observe the effectiveness and safety of clopidogrel combined with fibrinolytic therapy for acute ST segment elevation myocardial infarction （STEMI）. Methods From January 2004 to December 2006, a total of 158 STEMI patients in our hospital were treated with fibrinolytic agents combined with or without clopidogrel. There were 84 patients in clopidogrel group, including 66 （78.6%） male, 18 （ 2 1. 4% ） female and 45 （ 53.6% ） elderly patients （ aged ≥ 60 years） ;74 patients were in control group,including 58（78.4% ） male, 16 female（21.6% ）and 40（54. 1% ）elderly patients. Clinical characteristics, patency of infarct-related artery（IRA） ,30 d major adverse cardiac events （ MACE）, recurrent angina and hemorrhage events of the two groups were retrospectively analyzed. Efficacy and safety of fibrinolytic therapy combined with clopidogrel in elderly patients（ ≥60 years old）subgroup were also estimated. Results Baseline clinical characteristics between the two groups were comparable. Clopidogrel therapy was associated with a higher proportion of patent IRA（69. 1% vs 51.4% ,P =0. 035）and lower rates of cardiac death（0 vs 6. 8% ,P =0. 047） and MACE（2. 4% vs 12. 2% ,P = 0. 036）. There was no significant difference in the incidence of recurrent angina（ 3.6% vs 2.7%, P = 0. 885） ,slight and severe hemorrhage events（7. 1% vs 9. 5% ,P = 0. 811 ;1.2% vs 1.4% ,P = 0. 533）between the two groups. In elderly patients, clopidogrel therapy was associated with a higher proportion of patent IRA（68.9% vs 45. 0%, P =0. 045）,the declining tendency in MACE（2. 2% vs 12. 5% ,P = 0. 155）, but no significant differences in the other indexes. There were no significant differences in above-mentioned indexes between the elderly and younger patients in cloidogrel group. Conclusion Addition of clopidogrel to fibrinolytic therapy is safe and effective for both the elderly and younger STEMI patients.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第22期1759-1762,共4页
Chinese Journal of Practical Internal Medicine
基金
全军首批高新技术重大项目[卫医字第18号]
关键词
心肌梗死
急性
氯吡格雷
溶栓
Myocardial infarction, acute
Clopidogrel
Fibrinolytic therapy
