Analysis Of Efficacy And Safety Of Ticagrelor And Clopidogrel In Patients With Acute Coronary Syndrome After Elective Percutaneous Coronary Intervention

Part 1 Objective To investigate the difference between clinicians application for ticagrelor and clopidogrel,and to explore the efficacy and safety of ticagrelor and clopidogrel in patients with acute coronary syndrome(ACS)and undergoing elective percutaneous coronary intervention(PCI).Methods 2276 cardiovascular patients were selected in Xijing Hospital,of which 1159 cases were diagnosed as ACS and undergoing PCI.The patients were divided into ticagrelor group and clopidogrel group.In 1 year of follow-up,3 cases were excluded,27 cases were lost,and ultimately 1129 cases were enrolled,including ticagrelor group(n=303)and clopidogrel group(n=826).Compare the two groups of patients with baseline data and major adverse cardiovascular events(MACCE,including cardiovascular death,ischemia driven revascularization,ischemic stroke)and major bleeding events(type 2,type 3 and type 5 in bleeding academic research consortium).Results In the ultimately 1129 cases,303 patients(26.84%)were in ticagrelor group.Patients in ticagrelor group undergo high TNI,low LVEF value,more stent numbers,maximal stenosis rate,multiple complex lesions,transradial approach,multiple PCI(P< 0.05).There was no significant difference in the two groups of MACCE events(15.18%:12.59%,HR=1.226,95% confidence interval(CI)0.867-1.735,P=0.249)and major bleeding events(0.66%:0.73%,HR=1.093,95%CI 0.212-5.634,P=1.000),the difference was not statistically significant.Conclusion The efficacy and safety of ticagrelor and clopidogrel is identical.The clinician bias for patient selection on the condition of ticagrelor.Part 2Objective To investigate the efficacy of clopidogrel in patients with acute coronary syndrome(ACS)and undergoing elective percutaneous coronary intervention(PCI),under the condition of gene detection.Methods In the ultimately 1129 cases,933 cases of the patients were selected to detect genotype,including ticagrelor group(n=239)and clopidogrel group(n=694).The patients were divided into fast metabolism type,intermediate metabolism type and slow metabolism type according to the function loss of allele.Compare the two groups of patients with major adverse cardiovascular events(MACCE,including cardiovascular death,ischemia driven revascularization,ischemic stroke)in the different type.Results In the selected 933 cases,239 patients(25.62%)were in ticagrelor group.Patients in ticagrelor group still undergo high TNI,low EF value,more stent numbers,maximal stenosis rate,multiple complex lesions,multiple PCI(P<0.05).In the fast metabolism group,clopidogrel was used significantly higher than that of ticagrelor(46.25%:35.15%,OR=1.588,95%CI 1.171-2.153,P=0.003).In the intermediate metabolism group,clopidogrel was used similar with ticagrelor(46.54%:42.26%,OR=1.190,95%CI 0.884-1.601,P=0.251).In the slow metabolism group,clopidogrel was used significantly lower than that of ticagrelor(7.20%:22.59%,OR=0.266,95%CI 0.175-0.404,P<0.001).In the fast metabolism group,clopidogrel is a protective factor(HR=0.481,95%CI 0.268-0.863,P=0.014).In the intermediate metabolism group,clopidogrel has a protective trend(HR=0.710,95%CI 0.409-1.233,P=0.224).In the slow metabolism group,clopidogrel is a risk factor(HR=3.481,95%CI 1.122-10.799,P=0.031).There was a significant interaction between clopidogrel and its genotype(HR=2.255,95%CI 1.303-3.904,P=0.004).Conclusion Overall the efficacy of ticagrelor and clopidogrel is identical.But in the slow metabolism group,the clinical benefit of clopidogrel is obviously better than that of ticagrelor,while in the fast metabolism group,the clinical benefit of clopidogrel is obviously worse than that of ticagrelor.The clinician bias for clopidogrel in the patients with fast metabolism and ticagrelor in the patients with slow metabolism.Part 3 Objective To investigate the effect of healthy lifestyle on the prognosis of elective percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS)and Call for detailed implementation of healthy lifestyle standards,and enhance patient compliance.Methods The ultimately 1129 patients were divided into healthy lifestyle group(n=294)and control group(n=835)by whether improvement or adhere to a good lifestyle.1 years after PCI,compared the two groups of patients with main adverse cardiovascular and cerebrovascular events(MACCE,including cardiovascular and cerebrovascular death,ischemia driven revascularization and stroke)and the angina events.Results Of the 1129 patients enrolled,only 294 patients(26.04%)improve or adhere to at least one good lifestyle,among which 230 patients chose to quit smoking,45.01% of the patients who smoked,112 cases of patients focus on good eating habits,9.92% of the total number,118 patients adhere to the movement recovery,10.45% of the total number.The rate of MACCE in healthy lifestyle group was significantly lower than that in the control group(9.86%:15.21%,HR=0.642,95%CI 0.429-0.962,P=0.032)and the difference was statistically significant(P<0.05).Univariate analysis of prognostic factors including: healthy lifestyle,city residents,left ventricular ejection fraction is a protective factor,while hyperlipidemia,stent number and maximal stenosis rate is a risk factor.The result of Cox proportional hazards regression model analysis made good use of the factors that may affect the prognosis of patients as a factor stepwise.(HR=0.642,95%CI 0.429-0.962,P=0.033)Conclusion Healthy lifestyle can significantly reduce the incidence of MACCE in one year and benefit the patients after elective PCI,but the compliance of the patients is not ideal.