| Objective To evaluate the prevention and treatment effects of ticagrelor on STEMI patients with coronary artery no-reflow after primary PCI and the prognostic analysis of one year.Methods We selected 764 patients were diagnosed with acute ST-segment elevation myocardial infarction(STEMI)from January 2016 to October 2019,who were accomplished immediate percutaneous coronary intervention(PCI)treatment at the Department of Cardiology,General Hospital of Ningxia Medical University.According to the types of preoperative oral P2Y12 inhibitors,they were assigned into ticagrelor group(354 cases)and clopidogrel group(410 cases).The baseline digitals,laboratory datas,intervention related quotas and occurrence of no reflow after PCI were contrasted between them,and the risk of adverse cardiovascular events and bleeding events in the two groups within at least 12 months after the follow-up was analyzed.Multivariate Cox regression analysis and Kaplan Meier curves were also plotted.Results There were no statistical difference between the two groups of patients in terms of baseline datas such as age,body mass index,previous related medical history,laboratory digitals such as blood sugar and blood lipids at onset,and characteristics such as stent length and diameter(P>0.05).For single vessel coronary artery disease,the occurrence of the ticagrelor group was lower than the clopidogrel group,and differentiation was factually significant(28.61% VS 36.74% P=0.016),when the coronary artery was not single-vessel disease,the difference between the two groups was not notably significant(P>0.05).The occurrence of postoperative coronary blood flow TIMI level 3 in the ticagrelor group was obviously improved than that clopidogrel group,and the incidence of no recurrence was notably reduced than clopidogrel group(P<0.05)In terms of the characteristics of coronary artery disease,the occurrence of single-vessel coronary artery disease in the clopidogrel group exceeded the ticagrelor group,while the occurrence of left circumflex artery as a criminal vessel was higher than the clopidogrel group(P<0.05).There was no obvious difference in the incidence of non-single-vessel coronary artery disease,the offending vessel being the left anterior descending artery or the right coronary artery(P>0.05).Ticagrelor group of major cardiovascular adverse events was notably lower than the clopidogrel group(12.46%VS30.66% P = 0.000),and there was no distinction in bleeding events between the two groups.Constituting the main factors in adverse cardiovascular events,compared with the clopidogrel group,the ticagrelor group had a clearly lower incidence of all-cause mortality,again myocardial infarction,cardiovascular death and recurrent angina(P <0.05).There was no clear distinction in the comparative analysis of non-cardiovascular death,revascularization,stent thrombosis,and stroke between the two groups(all P>0.05).Multivariate Logistic regression and Kaplan Meier curve showed that ticagrelor was significantly associated with lower all-cause mortality,cardiovascular mortality and MACE.There was no abnormality in the incidence of bleeding in the two groups.Conclusion Ticagrelor could increase the coronary TIMI3 blood flow classification of infarcted coronary artery after PCI and effectively reduce the occurrence of coronary no-reflow events in STEMI patients,and significantly reduce the risk of adverse cardiovascular events one year without increasing the occurrence of bleeding events。... |
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