The Effects Of Triple Antiplatelet Therapy On Inflammation Reaction And Endothelial Function In Patients With Coronary Heart Disease After Interventional Therapy

Objective:To discuss the effects and safety of triple antiplatelet therapy on inflammation reaction, endothelial function, prognosis in patients with coronary heart disease after interventional therapy.Methods:130 patients who accorded with the diagnostic criteria of coronary heart disease and underwent PCI therapy were chosed and randomly divided into control group and therapy group,65 cases in each group. The general conditons, such as age, gender, body mass index, hypertension, type 2 diabetes, hyperlipidemia, smoking, coronary heart disease classification, previous PCI, lesion, the number of stents, stent diameter, stent length in two groups were comparable (P>0.05). The patients in control group received dual antiplatelet therapy, which was aspirin plus clopidogrel; the patients in therapy group received triple antiplatelet therapy, which was aspirin, clopidogrel plus low dose tirofiban. To compare the high-sensitivity C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), nitric oxide (NO), endothelin-1 (ET-1), von Willebrand factor (vWF) troponin I (cTnI) levels and flow-mediated brachial artery endothelium-dependent vasodilation (FMD) of patientsbefore and after surgery in two groups. To record the incidences of thrombocytopenia and bleeding during hospitalization and observe the incidences of restenosis and major cardiovascular events in 6 month after surgery.Results:1 Compared with the control group, the high-sensitivty CRP levels in therapy group signicantly decreased in 1 day and 7 day after surgery, the difference was statistically significant (P<0.05).2 Compared with the control group, the TNF-a level in therapy group signicantly decreased in 1 day after surgery, the difference was statistically significant (P<0.05); and the TNF-a level slightly decreased in 7 day after surgery.3 Compared with the control group, the IL-6 level in therapy group signicantly decreased in 1 day after surgery, the difference was statistically significant (P<0.05); and the IL-6 level slightly decreased in 7 day after surgery.4 Compared with the control group, the MCP-1 levels in therapy group signicantly decreased in 1 day and 7 day after surgery, the difference was statistically significant (P<0.05).5 Compared with the control group, the FMD in therapy group slightly increased in 1 day and 7 day after surgery.6 Compared with the control group, the NO level in therapy group signicantly increased in 1 day after surgery, the difference was statistically significant (P<0.05); and the NO level slightly increased in 7 day after surgery.7 Compared with the control group, the ET-1 levels in therapy group signicantly decreased in 1 day and 7 day after surgery, the difference was statistically significant (P<0.05).8 Compared with the control group, the vWF level in therapy group signicantly decreased in 1 day after surgery, the difference was statistically significant (P<0.05); and the vWF level slightly decreased in 7 day after surgery.9 Compared with the control group, the cTnI levels in therapy group signicantly decreased in 1 day and 7 day after surgery, the difference was statistically significant (P<0.05).10 Compared with the control group, the incidence of restenosis declined, from 20% to 9.23%, in therapy group in 6 month after surgery (X2=3.020,P=0.135).11 Compared with the control group, the incidence of major cardiovascular events declined, from 21.54% to 7.69%, in therapy group in 6 month after surgery, the difference was statistically significant(X2=4.993, P=0.045).12 During hospitalization, the control group with mild thrombocytopenia 5 cases, moderate thrombocytopenia 3 cases, severe thrombocytopenia 1 case, and the total incidence rate was 13.85%; the therapy group with mild thrombocytopenia 3 cases, moderate thrombocytopenia 2 cases, and the total incidence rate was 7.69%, the difference was not statistically significant (X2= 0.769, P= 0.560); the control group with minor bleeding 6 cases, moderate bleeding 2 cases, and the total incidence rate was 12.31%; the therapy group with minor bleeding 3 cases, moderate bleeding 1 case, and the total incidence rate was 6.15%, the difference was not statistically significant (X2= 0.769, P= 0.560).Conclusion:For patients with coronary artery disease and undergoing PCI, triple antiplatelet therapy was worth to be recommended clinical application, as it was able to release inflammation reaction and endothelial dysfunction, improve prognosis, but not significantly increased adverse reactions.