Baseline characteristics.

From the restriction of access to primary percutaneous coronary intervention, about 46% of patients with ST-elevation acute coronary syndrome (STE-ACS) received fibrinolytic therapy as a reperfusion strategy; streptokinase is frequently used in Thailand. Despite the guidelines recommending potent P2Y12 inhibitors among these patients, the data are limited, especially among patients with STE-ACS post streptokinase therapy. The study was proposed to describe factors for P2Y12 inhibitors selection and evaluate outcomes of pharmacoinvasively treated STE-ACS receiving ticagrelor compared with clopidogrel in Thailand. We performed a retrospective observational study of patients with STE-ACS post streptokinase therapy followed by percutaneous coronary intervention (PCI) with coronary stent placement and receiving ticagrelor or clopidogrel as P2Y12 inhibitor treatment from January 2017 to June 2021. The primary outcomes described factors for P2Y12 inhibitor selection and evaluated safety outcomes with inverse probability weight (IPW) adjustment. The secondary outcome was a composite of all-cause death, myocardial infarction and stroke. The median time from streptokinase therapy to initiating ticagrelor in the switch group was 25.7 (IQR, 1.9–4.4) hours. The factors related to switching from clopidogrel to ticagrelor included young age, history of coronary artery disease (CAD), dose of streptokinase and use of intravascular imaging. Any bleeding events occurred among 83 patients (41.71%) in the switch group and 83 patients (41.09%) in the no switch group (adjusted HR 1.04, 95% CI 0.75–1.44; p = 0.826). The composite of efficacy outcomes occurred in 6 patients in the switch group (3.02%) and 12 patients (5.94%) in the no switch group (adjusted HR 0.57, 95% CI 0.21–1.57; p = 0.279). Conclusion: In real practice, ticagrelor switching among patients with STE-ACS post streptokinase therapy did not differ regarding safety outcomes and composite of efficacy outcomes compared with clopidogrel.

受直接经皮冠状动脉介入治疗可及性的限制，约46%的ST段抬高型急性冠状动脉综合征（ST-elevation acute coronary syndrome, STE-ACS）患者接受了纤溶治疗作为再灌注策略；在泰国，链激酶（streptokinase）的使用较为普遍。尽管指南推荐在此类患者中使用强效P2Y12抑制剂，但相关研究数据较为匮乏，尤其是针对链激酶治疗后的ST段抬高型急性冠状动脉综合征患者。本研究旨在阐明泰国地区接受药物-介入联合治疗的ST段抬高型急性冠状动脉综合征患者中，P2Y12抑制剂的选择影响因素，并对比接受替格瑞洛（ticagrelor）与氯吡格雷（clopidogrel）的患者预后结局。本研究纳入2017年1月至2021年6月期间，接受链激酶治疗后行经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）并置入冠状动脉支架，且接受替格瑞洛或氯吡格雷作为P2Y12抑制剂治疗的ST段抬高型急性冠状动脉综合征患者，开展回顾性观察性研究。主要结局为分析P2Y12抑制剂的选择影响因素，并通过逆概率加权（inverse probability weight, IPW）校正以评估安全性结局。次要结局为全因死亡、心肌梗死与脑卒中的复合终点。换用组中，从链激酶治疗至启动替格瑞洛治疗的中位时间为25.7（四分位间距，1.9~4.4）小时。影响患者从氯吡格雷换用替格瑞洛的因素包括较年轻的年龄、冠状动脉粥样硬化性心脏病（coronary artery disease, CAD）病史、链激酶给药剂量以及血管内成像技术的使用。换用组共有83例患者（41.71%）发生任何类型出血事件，未换用组则有83例患者（41.09%）发生出血事件（校正后风险比（hazard ratio, HR）1.04，95%置信区间（confidence interval, CI）0.75~1.44；p=0.826）。疗效复合终点事件在换用组中发生6例（3.02%），未换用组中发生12例（5.94%；校正后HR 0.57，95% CI 0.21~1.57；p=0.279）。结论：在真实世界临床实践中，与氯吡格雷相比，链激酶治疗后的ST段抬高型急性冠状动脉综合征患者换用替格瑞洛并未在安全性结局与疗效复合终点方面表现出显著差异。