Efficacy And Safety Of Ticagrelor In The Elderly Patients With Acute Coronary Syndrome Undergoing Selective Percutenous Coronary Intervention

Objectives: To evaluate the efficacy and safety of the ticagrelor in the elderly Patients with acute coronary syndrome(ACS)undergoing selective percutenous coronary intervention(PCI).Methods: From January 2013 to December 2014,a total of 80 patients with first-time ACS and age >65years old who were admitted to the second Hospital of Hebei Medical University were enrolled in this study.All the patients were randomized into clopidogrel group(n=41)and ticagrelor group(n=39).Patients in clopidogrel group were received 300 mg clopidogrel followed by 75mg/d.Patients in ticagrerlor group were given 180 mg ticagrelor followed by 90 mg twice a day.Other medications were used according to the guidelines recommend.The basic clinical data,laboratory test results and inspections of all the patients were collected.The pre-PCI platelet aggregation rate(PAR),the level of serum BNP of admission,7th day post-PCI and the creatinine of admission,pre-PCI and 24 th hour post-PCI were recorded.All the patients underwent elective PCI treatment.TIMI flow,the corrected TIMI frame count(CTFC),and TIMI myocardial perfusion grade(TMPG)were compared.The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)were observed and recorded by echocardiography at admission,post-PCI 7thday and 1st month.The major adverse cardiac events(MACE)and bleeding events were followed up for 1month.All statistical data were dealt with SPSS 20.0,and P<0.05 was considered statistically significant.Results:1 No significant difference in baseline clinical characteristics was found between two groups(all P>0.05),including age,gender,weight,smoking history,hypertension,dyslipidemia,GRACE score,CRUSADE score.There were no significant differences in intervention approach,the number of stent implant,the dose of contrast agents,the low molecular weight heparin(LMWH),the percentage of tirofiban and oral drugs between two groups had no significant difference.2 The PAR and HPR in ticagrelor group were lower than those in clopidogrel group(30.49±8.43 vs 45.10±10.15,P<0.001).The two groups had significant differences(12.2%vs 0,P=0.026).3 The level of serum BNP in the two groups were not different at admission(P > 0.05).The level of serum BNP in the two groups at 7thday post-PCI were lower than those at admission,and the level of serum BNP in ticagrelor group compared with that of clopidogrel group was significantly lower(160.50±73.50)pg/ml vs.(226.80±117.43)pg/ml,P=0.004.4 The level of Hs-CRP in the two groups at admission and pre-PCI had no significant differences,but in the both groups the Hs-CRP at 24 th hour post-PCI were significantly higher compared with those at pre-PCI(14.72±5.77)mg/l vs.(7.85 ± 4.14)mg/l,P < 0.001;(12.92 ± 6.70)mg/l vs.(7.21 ±4.40)mg/l,P<0.001.The level of Hs-CRP in ticagrelor group were lower than those of clopidogrel group at 24 thhour post-PCI and 7thday post-PCI,and the level of Hs-CRP in ticagrelor group was significantly lower than that of clopidogrel group(8.66±4.37)mg/l vs.(10.99±4.11)mg/l,P=0.016.5 The value of LVEF in the two groups were not different at admission and 7th day post-PCI(P>0.05),the value of LVEF at 1st month post-PCI in the two groups were higher than baseline,and the value of LVEF in ticagrelor group at 1stmonth post-PCI was higher compared with that in clopidogrel group(P>0.05).The values of LVEDD in the two groups at admission had no differences,but tended to decrease gradually after treatment.The values of LVEDD at 7thday post-PCI and 1stmonth post-PCI in ticagrelor group were lower compared with those in clopidogrel group(P>0.05).6 The percentage of TIMI 3 and TMPG3 post-PCI in ticagrelor group were higher than those in clopidogrel group(85.3%vs 92.3%,P=0.483;87.1%vs 73.1%,P=0.164).The CTFC of ticagrelor group was loss than thatof clopidogrel group(22.74±2.67 vs 29.05±6.32,P<0.001).7 The levels of creatinine and uric acid in the two groups had no significant differences at the different time(all P>0.05),while the percentage of contrast nephropathy had no significant differences between the two group(5.1%vs 2.4%,P=0.611).8 During the period of in hospital,there were 3 cases of minor bleeding in the ticagrelor group while there were 2 cases of minor bleeding in the clopidogrel group,which were associated with PCI,but the data of the two groups had no significant differences((P>0.05)).At the same time,there were4 cases in the ticagrelor group appeared dyspnea,but the data of the two groups had no significant differences(P>0.05).During the period of follow-up,1case readmission because of angina in clopidogrel group and 1 case in the ticagrelor group appeared gingival bleeding and 3 cases in with dyspnea(P>0.05).But there was no tardy arrhythmia appeared between two group within 30 days after PCI.Conclusions:1 Ticagrelor not only has faster,stronger anti-platelet effect,but also improve myocardial perfusion,myocardial preservation,inhibiting inflammation and other multiple functions in the elderly patients with ACS.2 It is effective and safe of ticagrelor in the elder patients with ACS undergoing selective PCI.