The Effect Of Ticagrelor On Patients Undergoing Percutaneous Coronary Intervention With Acute Coronary Syndrome

Background and aimsWith the improvement of living level, increase of stress at work and bad living habits,the incidence of acute coronary syndrome (ACS) increase fast. Percutaneous coronaryintervention (PCI) has become the first choice of ACS treatment in the past two decades.The serious adverse cardiocerebral events happens much more in patients undergoing PCIwith ACS than in patients with stable angina pectoris, because platelet are moreaggregatible in early metaphase of ACS. A plenty of antiplatelet drugs such as clopidogrelare widely used in PCI, although clopidogrel acts slow, lente, invariable, inreversible andat a high risk of hemorrhage.Ticagrelor is a new kind of platelet aggregation inhibitors. The PLATO studyindicated that ticagrelor acts faster and much more variable than clopidogrel recently used.It can significantly decrease the mortality and incidence of myocardio infarction. However,I have limited evidence of the ticagrelor effects on PCI patients in China. More clinic trailsneed to be carried out to evaluate the indication in different subgroup patients.This study Objective to evaluate the effect of ticagrelor on patients undergoing percutaneous coronary intervention with acute coronary syndrome in China, analyse therelationship between ticagrelor and patients with ACS complicated with severevasculopathy.Methods159patients with coronary heart disease diagnosed as ACS by coronary arteriographyin the department of cardiology in our hospital had completed PCI.159patients wererandomed into clopidogrel treated group (n=80) and ticagrelor treated group (n=79).Serumwas collected before surgery and24hours after surgery for ELISA to determine plasmaALT, Cr, CK-MB, cTn I and PRU. Ultracardiography were performed in6month post-PCI.All patients were followed6months post-PCI for main adverse cardiovascular andcerebrovascular events (MACCE).A subgroup analysis was further performed on mild and severe subgroups (75vs84),which was determined by the SYNTAX score. The values of plasma ALT, Cr, CK-MB,cTn I, PRU, ultracardiography and MACCE rate were analysed in subgroups.ResultsCK-MB, cTn I and LVEDD were significantly decreased in the ticagrelor treatedgroup compared with clopidogrel treated group(P＜0.05). Meanwhile, Cr, PRU and LVEFwere significantly increased in the ticagrelor treated group compared with clopidogreltreated group(P＜0.05). No significantly difference was noted in baseline and ALTbetween two groups. Patients in ticagrelor treated group showed significantly lowerMACCE rate compared with patients in clopidogrel treated group in the postoperativemonth-6follow-up(P＜0.05). In the severe subgroup, CK-MB, cTn I and LVEDD weresignificantly decreased and Cr, PRU and LVEF were significantly increased in theticagrelor treated group compared with clopidogrel treated group(P＜0.05). Further more,a significantly lower MACCE rate was also showed in severe subgroup(P＜0.05).ConclusionTicagrelor can significantly decrease the mortality and incidence of myocardioinfarction in patients undergoing percutaneous coronary intervention with acute coronarysyndrome. It can better improve the outcomes of patients with severe vasculopathy.