ティカグレルとプラスグレルで治療されたSTセグメント上昇性心筋梗塞のリヴァスキュラライズされた患者の微血管損傷の評価
Maarten A H van Leeuwen1,2, Nina W van der Hoeven1, Gladys N Janssens1
1Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L., N.W.v.d.H., G.N.J., H.E., A.N., J.S.L., G.A.d.W., A.C.v.R., R.N., N.v.R.).
Circulation
|December 28, 2018
まとめ
プラスグレルと比較してチカグレロの維持治療は,ST上昇心筋梗塞後の冠動脈微血管損傷を有意に減少させなかった. 両方の治療は1ヶ月後に類似した心臓発作の大きさとマイクロ血管阻害率をもたらしました.
科学分野:
- 心臓病科
- 薬理学について
- 介入心臓科
背景:
- 冠動脈微小血管損傷は,成功した再血管化にもかかわらず,STセグメント上昇性心筋梗塞 (STEMI) の後に一般的であり,患者の結果に影響を与えます.
- アデノシンレベルを上昇させるチカグレロルの可能性は,マイクロ循環に対する保護効果の可能性を示唆する.
- この研究は,STEMI患者におけるマイクロ血管損傷の予防のためのチカグレロとプラスグレルの比較を目的とした.
研究 の 目的:
- 経皮冠動脈干渉 (PCI) の後のSTEMI患者におけるプラスグレルと比較して,チカグレローの維持治療が冠動脈微小血管損傷を減少させるかどうかを評価する.
- 微循環抵抗指数 (IMR) と心臓発作の大きさに対するチカグレロの影響を評価する.
主な方法:
- 主要PCIを受けている110人のSTEMI患者を対象としたランダム化試験です.
- 患者はチカグレロまたはプラスグレルの維持療法を受けた.
- 冠動脈微血管損傷は,微循環抵抗指数 (IMR) と心血管磁気共鳴画像 (CMR) を用いて1ヶ月後に評価された.
主要な成果:
- ティカグレロとプラスグレル群のIMRの有意な差は認められませんでした (P=0. 08).
- チカグレロは心臓内出血の減少と関連していた (23%対43%,P=0. 04).
- 心臓発作の大きさや微小血管阻害の有意な差異は観察されなかった.
結論:
- STEMI患者における冠動脈微小血管損傷の予防に,チカグレローの維持療法はプラスグレルより優れていない.
- 2つの薬剤はPCI後1ヶ月で類似した心臓発作の大きさと小血管阻害を引き起こします.
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