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首页> 外文期刊>The American Journal of Cardiology >Usefulness of pretreatment with high-dose clopidogrel in patients undergoing primary angioplasty for ST-elevation myocardial infarction.
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Usefulness of pretreatment with high-dose clopidogrel in patients undergoing primary angioplasty for ST-elevation myocardial infarction.

机译：大剂量氯吡格雷预处理在ST段抬高型心肌梗死的原发性血管成形术中的作用。

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We evaluated the effect and optimal dose of clopidogrel pretreatment in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention (PPCI). The study included 383 consecutive patients with ST-elevation myocardial infarction who had undergone PPCI and were prospectively followed up for a prespecified primary end point of recurrent acute coronary syndrome, stent thrombosis, congestive heart failure, and/or death at 30 days. Of these patients, 217 (57%) received clopidogrel loading before and 166 (43%) after PPCI. A similar number received low (300 mg) and high (600 mg) clopidogrel doses before and after PPCI. Clopidogrel loading before, compared with after, PPCI was associated with a lower incidence of the primary end point (21.7% vs 33.7%, p = 0.008). Clopidogrel pretreatment remained a significant predictor of the primary outcome after adjusting for potential confounders (odds ratio 0.54, 95% confidence interval 0.42 to 0.91). When patients were further stratified into 4 groups according to the timing and dosage of clopidogrel loading, the incidence of the primary outcome was 16% and 27% in those receiving 600 and 300 mg before and 28% and 39% in those receiving 600 and 300 mg after PPCI, respectively (p for trend <0.01). In conclusion, both the timing and the dosage of clopidogrel loading are important and affect the outcome in patients with ST-elevation myocardial infarction undergoing PPCI.
机译：我们评估了氯吡格雷预处理对初次经皮冠状动脉介入治疗（PPCI）的ST抬高型心肌梗死患者的疗效和最佳剂量。该研究纳入了383名连续性ST抬高型心肌梗死患者，这些患者均接受了PPCI治疗，并对30天内复发的急性冠状动脉综合征，支架血栓形成，充血性心力衰竭和/或死亡进行了预先指定的主要终点随访。在这些患者中，有217名（57％）在PPCI之前和之后有166名（43％）接受了氯吡格雷治疗。在PPCI之前和之后，相似数量的患者接受了低剂量（300 mg）和高剂量（600 mg）氯吡格雷治疗。 PPCI之前和之后的氯吡格雷负荷与主要终点发生率较低相关（21.7％vs 33.7％，p = 0.008）。调整潜在混杂因素后，氯吡格雷预处理仍是主要结局的重要预测指标（赔率为0.54，95％置信区间为0.42至0.91）。当根据氯吡格雷负荷的时间和剂量将患者进一步分为4组时，接受600和300 mg的患者的主要结局发生率分别为16％和27％，接受600和300 mg的患者的主要结局为28％和39％ PPCI后分别为mg（趋势<0.01的p）。总之，氯吡格雷负荷的时机和剂量都很重要，并且会影响接受PPCI的ST抬高型心肌梗死患者的结局。

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