The Efficacy And Safety Of Chewing Ticagrelor Before Primary PCI In Patients With ST-elevation Myocardial Infarction

Objectives To evaluate the efficacy and safety of chewing a loading dose of ticagrelor before primary PCI in patients with acute ST-segment elevation myocardial infarction.Methods We performed a study in 218 STEMI patients who underwent primary PCI in Tangshan Gongren Hospital from December 2018 to December 2019,the patients were randomly assigned to chewing group(n=113)and routine oral group(n=105).The patients in the two groups were treated with a chewed 180 mg loading dose of ticagrelor and standard oral administration of an equal dose respectively,before undergoing primary PCI.LC-MS/MS Assay was used to evaluate the quantitative determination of ticagrelor in plasma.PL-12 platelet function analyzer and Verify Now assay were used to measure platelet function of patients in each group after taking ticagrelor loading dose at various time point.The myocardial perfusion(including ST-segment elevation resolution at 2h after primary PCI,TIMI flow grade,corrected TIMI frame count and TIMI myocardial perfusion grade)were compared between the two groups.The cardiac function(including left ventricular end-diastolic dimension and left ventricular ejection fractions)were compared between the two groups at 24 h after primary PCI.The major adverse cardiovascular and cerebrovascular events(including cardiovascular death,myocardial infarction,stroke,target vessel revascularization,unstable angina and heart failure),bleeding events defined as BARC grades 1～5 and stent thrombotic were investigated between the two groups after a follow-up time of 90 days.Kaplan-Meier analysis and logrank test were used to evaluate survival analysis of patients between the two groups.Results 1 Baseline characteristics were similar in both groups(P>0.05);2 The maximum aggregation rate and P2Y12 reaction units of patients in chewing group at 0.5h and 1h were significantly lower than those in routine oral group(P<0.01),while were no significant difference at 0h,2h and 4h respectively(P>0.05);3 No matter which kind of platelet function test method was used,the number of patient with high platelet reactivity in chewing group at 0.5h and 1h were significantly lower than that in routine oral group(P<0.01),while were no significant difference at 0h,2h and 4h respectively(P>0.05);4 The quantitative determination of ticagrelor in plasma of patients in chewing group at 0.5h and 1h were significantly higher than that in routine oral group(P<0.01),while were no significant difference at 0h,2h and 4h respectively(P>0.05);5 The area under the concentration-time curve of patients in chewing group at 0.5h,1h and 2h were significantly higher than that in routine oral group(P<0.01),while were no significant difference at 0h,and 4h respectively(P>0.05);6The corrected TIMI frame count of patients in chewing group was significantly reduced after primary PCI and the ST-segment elevation resolution at 2h after the operation was significantly increased(P<0.05),compared with routine oral group.And there is no difference in TIMI flow grade and TIMI myocardial perfusion grade between two groups(P>0.05);7 The left ventricular ejection fractions of patients in chewing group at24 h after undergoing primary PCI were significantly higher than that in routine oral group(P<0.05),while left ventricular end-diastolic dimension were no significant difference at 24h(P>0.05);8 No significant difference was found between the two groups in the incidence of The major adverse cardiovascular and cerebrovascular events within90 days(P>0.05);9 Within 90 days,no significant difference was found between the two groups in the incidence of the bleeding events defined as BARC grades 1-5 and stentthrombotic(P>0.05).Conclusions Compared with standard oral administration,chewing ticagrelor before primary PCI in STEMI patients lead to a faster raising of ticagrelor in plasma and a more effective platelet inhibition,a improved partial myocardial perfusion and cardiac function,and it does not increase the incidence of bleeding events.There is a certain safety and efficacy in chewing ticagrelor before primary PCI in STEMI patients.Figure seven;Table eleven;Reference One hundred and thirty...