Efficacy And Safety Of Reoperative Loading Of Ticagrelor On Emergency Interventional Therapy In STEMI Patients

Objective: To investigate the efficacy and safety of reoperative loading of ticagrelor on emergency percutaneous coronary interventional(PCI)therapy in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods: A total of 208 patients with STEMI were recruited at the Sixth Affiliated Hospital of Guangxi Medical University from June 1,2015 to May 30,2016.They were randomly divided into ticagrelor(Group A,n = 103)and clopidogrel(group B,n = 105)by the order of admission and a random number table.Before PCI,all of the patients were treated using a load of aspirin(300mg),followed by 100 mg daily maintenance.Group A was treated with a load of tegrelol(180 mg),then 90 mg each time,two times a day to maintain,whereas group B was given a load of clopidogrel(300 mg)and then 75 mg once daily.In addition,all patients were given routine medication according to the STEMI guidelines.The thrombolysis in myocardial infarctiom(TIMI)blood flow of the coronary arteries was recorded in the two groups of patients after emergency PCI,the maximal platelet aggregation rate(MPA)of the two groups was measured before treatment,balloon dilatation or thrombosis,24 h after PCI and 7days after PCI.And 30 days after follow-up major cardiovascular events,bleeding events and the occurrence of dyspnea were also observed.Results: 1.In this study,three patients in group A and one case in group B were lost during follow-up.Finally,group A included 100 patients and group B included 104 cases in this study.The clinical basic data,including age,gender,hypertension,hyperlipidemia,diabetes,smoking,coronary syndromes,vascular disease,and door-to-balloon(D-2-B)time were not significantly different between the groups A and B(P > 0.05).2.The MPA was high in both groups before treatment,but the difference was not statistically significant(P = 0.441).The MPA during balloon dilatation or thrombosis and 24 h after PCI was decreased in the two groups,but it in group A decreased significantly,the difference between the two groups was statistically significant(P < 0.001 for all).There was a significant decrease in MPA between the two groups at 7 days after PCI,and there was significant difference between the two groups before treatment(P < 0.001 for all).There was no significant difference between the two groups(P = 0.267),but the MPA in group A was lower than that in group B.3.There were six cases of non-reflow(6.0%)in group A and twenty cases of non-reflow(19.2%)in group B after PCI,the difference was statistically significant(P = 0.005).4.The incidence of MACE was different,but there was no significant difference in the overall incidence of MACE(5.0% vs.6.7%,P = 0.848).5.The patients in Group A had eight cases of bleeding events,1 case of secondary bleeding,seven cases of mild bleeding,whereas they in group B had four cases of bleeding events,mild bleeding.Bleeding event was more in group A than in group B,but there was no significant difference in the incidence of bleeding between the two groups(8.0% vs.3.9%,P = 0.288).6.There were seven cases of dyspnea in group A and three cases in group B.There was no significant difference between the two groups(7.0% vs.2.9%,P = 0.245).Dyspnea can be tolerated with prolonged medication,without the need to adjust the drug or withdrawal.Conclusion: Gregory inhibits platelet aggregation faster,stronger,improved STEMI patients with no follow-up after PCI,and does not increase the risk of major bleeding,it is safe and effective in patients with STEMI who require emergency intervention.