The Value Of Ticagrelor In Treating Complex Coronary Artery Disease With Percutaneous Coronary Intervention

Background:In the past few decades,cardiac vascular disease(CVD)has gradually become the world's largest single death burden,especially coronary atherosclerotic heart disease(CHD)in which played a particularly important role.There are two main treatment for patients with coronary heart disease,namely:drug conservative treatment,coronary revascularization treatment.And these two kinds of treatment is complementary relationship,drug therapy is the cornerstone of coronary heart disease treatment,coronary artery revascularization is a means.Whether or not coronary revascularization,coronary heart disease patients need to take a lifetime medication.And the use of double antiplatelet regimens in patients with acute coronary syndromes(ACS)who underwent percutaneous coronary intervention(PCI).Ticagrelor is a new oral antiplatelet drugs,which can reversible antagonize P2Y12 receptor belongs to the adenosine diphosphate(ADP)receptor antagonist.Unlike the clopidogrel(thienopyridine drugs),which are widely used in clinical practice.Ticagrelor itself is an active drug,and the metabolites are also activated,with the characteristics of rapid onset and powerful effection.Because these favorable pharmacokinetics and pharmacodynamics,ticagrelor is paid more and more attention by clinicians.Tegrello has been written into many guidelines in the world,as the first line or preferred antiplatelet drugs in double anti-platelet program for acute coronary syndromes(ACS)patients.At present,although percutaneous coronary intervention(PCI)treatment has been widely used in ACS patients with complex coronary artery disease,but the complex coronary artery disease as a clinical critical illness compared with patients with normal disease still has a high risk.For these patients with complex coronary artery disease,antiplatelet therapy is the cornerstone which to ensure their lifeline.Before the influential "The Study of Platelet Inhibition and Patient Outcomes"(PLATO)research,as well as the Dayu research,Yinglong research and other research are aimed at ordinary ACS patients.So,we conducted this study,aimed at analysis of the value of ticagrelor in treating complex coronary lesions with PCI treatment.Methods:Patients with acute coronary syndrome hospitalized for PCI treatment of coronary lesions were randomed to two group according to the proportion of 1:1.After loading doses of ticagrelor 180 mg or clopidogrel 300 mg,patients will receive ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily.And all patients were routinely given aspirin(300 mg loading dose or sustained maintenance dose,100 mg/d maintenance dose).Patients who met the patients with coronary artery disease complicated with PCI were treated with tigrilil(n = 98),and patients taking clopidogrel in accordance with the criteria for complex coronary artery disease were treated with clopidogrel as chlorine Pigeonite group(n = 100).Except for patients who were lost,patients in the standard group were excluded from the group,80 patients in the tigrine group were enrolled in the group and 91 patients were enrolled in the clopidogrel group.The clinical data of the patients' patients were recorded,and the results of coronary angiography and PCI were performed.Each of patient was followed-up and performed in the first month and the sixth month after the PCI treatment.Comparison of major cardiovascular events(including death from any cause,myocardial infarction,revascularization of target lesion revascularization,and incidence of frequent angina pectoris)and the incidence of bleeding events in patients with ticagrelor and clopidogrel in the first month and the sixth month after the PCI treatment,and then we can analysis the value of ticagrelor in treating complex coronary lesions with PCI treatment.Results:1.In one month after PCI treatment,the incidence of major cardiovascular events in the ticagrelor group was significantly different from that in the clopidogrel group,with no statistically significant difference(P=0.47).2.In one month after PCI treatment,the incidence of type 1 bleeding events defined by the BARC study in the ticagrelor group was higher than that in the clopidogrel group,with no statistically significant difference(P=0.23).3.In six month after PCI treatment,the incidence of major cardiovascular events in the ticagrelor group(6.25%)was lower than that in the clopidogrel group(12.09%),but with no statistically significant difference(P=0.19).The incidence of recurrent angina was lower in the patients in the ticagrelor group(3.75%)than that in the clopidogrel group(9.89%),but with no statistically significant difference between the two groups(P=0.19).The incidence of myocardial infarction was lower in the ticagrelor group(1.25%)than that in the clopidogrel group(2.20%),but with no statistically significant difference between the two groups(P=0.91).4.In six month after PCI treatment,the incidence of bleeding events defined by the BARC study was significantly higher in the ticagrelor group(23.75%)than that in the clopidogrel group(8.79%),with a significant statistical difference(P = 0.0074).The incidence of type 1 bleeding events defined by the BARC study was higher in the ticagrelor group(18.75%)than that in the clopidogrel group(6.59%),with a statistical difference(P = 0.016).The incidence of type 2 bleeding events defined by the BARC study was lower in the ticagrelor group(2.50%)than that in the clopidogrel group(2.20%),with no statistically significant difference between the two groups(P=0.71).The incidence of type 3 bleeding events defined by the BARC study was higher in the ticagrelor group(2.50%)than that in the clopidogrel group,with no statistically significant difference between the two groups(P=0.22).The incidence of active bleeding events was higher in the ticagrelor group(5.00%)than that in the clopidogrel group(2.20%),with no statistically significant difference between the two groups(P=0.56).Conclusion:1.The incidence of major cardiovascular events in the ACS patients with complex coronary artery disease treated by ticagrelor was lower than that of clopidogrel and did not increase the incidence of BARC type 2 and above bleeding events.Based on the effect of acting faster and more effective than clopidogrel,ticagrelor is a good therapeutic agent for ACS patients with ACS complicated with coronary artery disease.2.The incidence of bleeding events such as ecchymosis and gingival bleeding was significantly higher in ticagrelor than that of clopidogrel in patients with ACS complicated with coronary artery disease.Although the BRAC type 1 Bleeding events does not usually require clinical treatment,but doctors should explain to the patient clearly,to avoid the self-medication.