Objective: To investigate the effects of ticagrelor on cardiorespiratory fitness in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods: A total of 1 073 patients, who were diagnosed as coronary heart disease and underwent cardiopulmonary exercise testing (CPET) within 1 year after PCI, were enrolled from September 2017 to September 2019 in Peking University Third Hospital, including 309 patients in ticagrelor group and 764 patients in clopidogrel group. Clinical information, blood test results, echocardiographic parameters, cardiorespiratory fitness related parameters (including peak oxygen uptake (VO(2)), anaerobic threshold VO(2), peak oxygen pulse (VO(2)/HR) and carbon dioxide ventilation equivalent (VE/VCO(2)) slope), coronary lesions and intervention information were obtained. Cardiopulmonary fitness related indexes were compared between the two groups, and the correlation between ticagrelor use and cardiopulmonary fitness related indexes was analyzed by multivariate logistic regression. Patients who underwent CPET within 1 month after PCI were included in the subgroup analysis. Results: In ticagrelor group, the age was (60.3±10.3) years, and 253(81.9%) cases were male. The age of clopidogrel group was (60.6±10.0) years, and there were 608(79.6%) males. No significant differences were observed in peak VO(2), anaerobic threshold VO(2), and peak VO(2)/HR between the two groups (all P>0.05), but the VE/VCO(2) slope was significantly higher in the ticagrelor group than in the clopidogrel group (30.075 (27.207, 33.603) vs. 28.853 (25.970, 32.336), P<0.001). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with the ticagrelor use (all P>0.05), while the VE/VCO(2) slope was independently correlated with ticagrelor use (OR=1.098, 95%CI 1.032-1.168, P=0.003). Subgroup analysis of patients who underwent CPET within 1 month after PCI also indicated that no significant difference were observed in peak VO(2), anaerobic threshold VO(2), peak VO(2)/HR and VE/VCO(2) slope between the two groups (all P>0.05). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with ticagrelor use (all P>0.05), while the VE/VCO(2) slope was significantly correlated with ticagrelor use (OR=1.132, 95%CI 1.030-1.244, P=0.010). Conclusion: Among coronary heart disease patients after PCI, treatment with clopidogrel does not result in significant decrease in exercise endurance as compared with patients treated with ticagrelor.
目的： 探讨替格瑞洛对经皮冠状动脉介入治疗（PCI）术后冠心病患者心肺适能的影响。 方法： 入选2017年9月至2019年9月于北京大学第三医院行PCI治疗，且在术后1年内行心肺运动试验（CPET）的冠心病患者1 073例进行回顾性分析，其中替格瑞洛组309例，氯吡格雷组764例。收集患者的一般临床资料、生化检验结果、超声心动图结果、心肺适能相关指标[包括峰值摄氧量（VO(2)）、无氧阈VO(2)，峰值氧脉搏（VO(2)/HR）及二氧化碳通气当量（VE/VCO(2)）斜率]、冠状动脉病变和介入治疗情况等。比较两组的心肺适能相关指标水平，采用多因素logistic回归分析服用替格瑞洛与心肺适能相关指标的相关性，并单独纳入PCI术后1个月内行CPET的患者进行亚组分析。 结果： 替格瑞洛组患者的年龄为（60.3±10.3）岁，男性253例（81.9%）；氯吡格雷组年龄（60.6±10.0）岁，男性608例（79.6%）。两组的峰值VO(2)、无氧阈VO(2)及峰值VO(2)/HR比较，差异无统计学意义（P均>0.05），但替格瑞洛组的VE/VCO(2)斜率高于氯吡格雷组[30.075（27.207,33.603）比28.853（25.970,32.336），P<0.001]。多因素logistic回归分析提示峰值VO(2)、无氧阈VO(2)及峰值VO(2)/HR与替格瑞洛应用无相关性（P均>0.05），而VE/VCO(2)斜率与应用替格瑞洛独立相关（OR=1.098，95%CI 1.032~1.168，P=0.003）。亚组分析也提示对于PCI术后1个月内行CPET的患者，两组的峰值VO(2)、无氧阈VO(2)、峰值VO(2)/HR及VE/VCO(2)斜率差异无统计学意义（P均>0.05）；多因素logistic回归分析提示峰值VO(2)、无氧阈VO(2)、峰值VO(2)/HR与应用替格瑞洛无相关性（P均>0.05），而VE/VCO(2)斜率与其独立相关（OR=1.132，95%CI 1.030~1.244，P=0.010）。 结论： 在PCI术后冠心病患者中，与服用氯吡格雷的患者比较，服用替格瑞洛者的运动耐力无明显下降。.
Keywords: Cardiorespiratory fitness; Coronary artery disease; Percutaneous coronary intervention; Ticagrelor.