Clinical Observation Of Anti Platelet Strategy In STEMI Patients With Different Degree Of Coronary Artery Disease

Objectives To compare the clinical efficacy of between Ticagrelor and Clopidogrel in treating the patients with acute ST-segment elevation myocardial infarction(STEMI),as the complexity of coronary disease.In order to obtain the prospective information of select personalized anti-platelet coagulation medication in clinical practice.Methods We selected 566 patients who admitted in the First Department of Cardiology in Tangshan Gongren Hospital diagnosed as STEMI during from January 2013 to July 2015.All patients underwent primary coronary angiography and received at least 12 months of dual antiplatelet therapy.Ultimately there were 512 patients under follow-up during 12 months.The period from May 2014 to July 2015 admitted and were diagnosed as STEMI received ticagrelor(90mg bid)combined with aspirin(100mg qd)patients as the study group,a total of 252 patients;the period from January 2013 to April 2014 were diagnosed as STEMI and received clopidogrel(75mg qd)combined with aspirin(100mg qn)patients as the control group,a total of 260 patients.According to the Gensini score all patients were divided into two groups,named the high score group and the low score group.Both of them were 256 patients,In the low score group including study group were 126 patients,and including the control group were 130 patients.In the high score group the number of patients same to the lowe one.Then followed up all those STEMI patients the MACE,bleeding events and adverse reactions during the following 12 months.MACE events including cardiac death,myocardial infarction,stroke,stent thrombosis,target vessel revascularization TVR,recurrent angina pectoris.Bleeding events included a slightly bleeding,minorly bleeding,majorly bleeding.Adverse reactions including dyspnea and bradycardia.All data were input Excel,and set up a database,statistical analysis used the SPSS 19.0 statistical software.Measurement data were presented as mean ± standard deviation ((?)±s).the pairwise comparisons using T-test for independent samples,Among groups by chi square(x2)test,between multiple sets of data were compared using ANOVA.Correlation between indiators using Person correlation analysis and correlation coefficient.The test level: P<0.05 said the difference was statistically significant.Results During the 12 months of following-up,The result showed that ticagrelor group compared to clopidogrel group MACE events(27.9% vs 45.6%,P < 0.01),the differencewas statistically significant.especially the stent thrombosis events(1.1% vs 4%,P=0.04)and the recurrent angina(14.5% vs 21.2%,P=0.048),the ticagrelor group lower than the clopidogrel group,the difference was statistically significant.The total incidence of hemorrhage of ticagrelor group compared with clopidogrel group(25.6% vs 17.6%,P=0.025),the difference was statistically significant.The incidence of bradycardia Ticagrelor was higher than clopidogrel group(6.9% vs 2.8%,P=0.033),the difference was statistically significant.In the high scores group the MACE events ticagrelor group lower than the clopidogrel group(37.3% vs 60.8%,P < 0.001),the difference was statistically significant.Ticagrelor had a lower incidence of heart failure(15.9% vs.27.7%,P=0.022),the difference was statistically significant.The total incidence of hemorrhage of ticagrelor higher than the clopidogrel group(32.5% vs 20%,P < 0.05),the difference was statistically significant.The incidence of slightly bleeding the ticagrelor group higher than the clopidogrel group(30.2% vs 18.5%,P=0.029),the difference was statistically significant.In the low scores group the study group and control group STEMI patients the total incidence rate of MACE,bleeding events and adverse reactions heart failure during the following 12 months,were no significant difference(P > 0.05).Conclusions 1 Ticagrelor compared with clopidogre can reduce the Major Adverse Cardiac Events,especially in case of stent restenosis and recurrent angina,but increase the case of a slightly bleeding and bradycardia.2 In STEMI patients with severe coronary artery disease the ticagrelor can significantly reduce the incidence of MACE events and heart failure,only increase the risk of slighly bleeding,the patients with mild coronary artery disease ticagrelor compared with clopidogrel have a same efficacy and safety.