Impacts Of Ticagrelor On Myocardial Microcirculation In Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Objective: This trial is aimed at evaluating the impacts of Ticagrelor on myocardial microcirculation in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods: In this randomized,single blinded test,patients who were diagnosed with ACS receiving PCI in the Second Hospital of Hebei Medical University from March 2015 to December 2015 were enrolled.Eligible patients were randomly assigned to receiving Ticagrelor(TA)or Clopidogrel(CA).Inclusion criteria:(1)The diagnostic criteria of ACS proposed by CSC in 2012;(2)Patients' family members have signed PCI informed consent;(3)Patients were performed CAG and PCI in hospital.Exclusion criteria:(1)Emergency vessel reconstruction operation;(2)Suspected Artic Dissection;(3)Cardiac shock;(4)Allergic to Ticagrelor or Clopidogrel;(5)Anticoagulant or antiplatelet contraindication;(6)Severe hepatic insufficiency(transaminase is greater than 2 folds of the normal upper limit),or severe renal insufficiency required dialysis treatment;(7)History of PCI/CABG operation,or specific signs of coronary artery side branches formation;(8)The presence of autoimmune diseases,severe trauma,bleeding disorders and tumors;(9)Patients refuse to sign the informed consent.Both group received the same basic medical treatment,including anticoagulant or antiplatelet meidicine,ACEI/ARB,CCB,beta-blocker,statins and nitrates.Beyond basic medication,patients in TA group were administered Ticagrelor 90 mg,twice a day.While patients in CA group were given Clopidogrel 75 mg per day.All patients enrolled were required to perform CAG and PCI in cardiology department.The baseline clinical characteristics,changes of cTnI,medical adverse effects were compared.During the operation,characteristic including TIMI flow grade before and after PCI procedure,corrected TIMI frame count(CTFC),TIMI myocardial perfusion grade(TMPG)were recorded.The incidence of major adverse cardiac events(MACE)between two groups was followed in 30 days.All clinical data were analyzed with SPSS 20.0.P Value of less than 0.05(2-tailed)was considered to be statistically significant.Results: Among 80 cases in this study,40 cases were randomly assigned to TA group(32 males,average age 59.35±9.34 years old)and 40 cases to CA group(29 males,average age 58.65±10.07 years old).1 Comparison about baseline clinical characteristics.There were no significant differences in both groups in baseline characteristics,including gender distribution,mean age,risk factors(hypertension,diabetes millitus,hyperlipidermia,smoking history),body mass index(BMI),creatinine,hemoglobin,low density lipoprotein,GRACE score,CRUSADE score,and basic medications(P>0.05).2 Comparison of angiographic and procedural characteristics:During PCI procedure,CAG showed there were no significant differences between two groups in the proportion of ischemic-related artery,the average length and diameter of stents,the percentage of TIMI grade 3 before/after PCI.The levels of CTFC of LAD,RCA in TA group were lower than those in CA group(LAD:18.51±6.12 vs.23.19±5.26,P=0.035;RCA:15.65±3.32 vs.19.86±5.67,P=0.029).There was no difference between two groups in the CTFC of LCX(14.97±6.42 vs.17.37±5.95,P=0.072).The percentage of TMPG grade 3 in TA group was higher than that in CA group(P=0.284).The incidence of slow/no-reflow was similar between groups(P>0.05).3 Changes of MDA and SODThere were no significant differences in the levels of MDA and SOD between both groups at admission(3.44±0.71?mol/L vs.3.44±0.72?mol/L,P=0.967;126.90±12.84U/L vs.126.94±12.82U/L,P=0.979).There were significant differences between two groups about MDA and SOD values at different time 24 hours after operation(4.67±0.83umol/Lvs.4.99±0.85 umol /L;P=0.023;100.92±10.14U/Lvs.95.94±10.36U/L,P=0.013)as well as 72 hour s after PCI(3.93±0.76umol/L vs.4.32±0.72umol/L,P=0.043;116.36±11.93 U/L vs.111.21±12.48U/L,P=0.049).4 Evaluation of the safety of TicagrelorIn TA group,there were 1 patient with dyspnea and 2 patient with slight bleeding as well as 1patient with slight bleeding in CA group.There was no significant difference in bleeding in both groups.No patient suffered from other complications like bradyarrhythmia allergic to medicine,severe bleeding,and shock.In the follow-up visit,one patient in TA group and two patients in CA group were rehospitalized because of cardiac reasons in 30 days.One suffered from severe heart failure in CA group.No malignant ventricular arrhythmia and cardiac death happened to patients in both group.No significant difference was found between two groups concerning the incidence of MACE.Conclusion: Ticagrelor could improve myocardial microcirculation in patients with ACS undergoing PCI safely,without obvious adverse effects.