Ticagrelor Versus Clopidogrel In Patients With Acute ST Segments Elevation Myocardial Infarction

Background:ST segment elevation acute myocardial infarction(STEMI)is a common type of acute coronary syndrome(ACS),with high death and disability rates,poor prognosis.Due to poor lifestyle,the incidence of acute ST elevation myocardial infarction rate increased year by year in China.At present,percutaneous coronary intervention(PCI)is the best treatment for STEMI patients with vascular lesions,which can effectively reduce the mortality of patients with STEMI.However,whether metal stents or drug-eluting stents,parts of patients received PCI suffer stent restenosis and other adverse events,and platelets play a pivotal role in the progression.Antiplatelet drugs can effectively reduce the incidence of adverse cardiovascular events by blocking platelet adhesion,activation and aggregation.Therefore,patients with STEMI treated with PCI should be routinely treated with antiplatelet drugs.Treatment with the combination of aspirin plus clopidogrel dual antiplatelet therapy still occupies an important position in China,and recent years the new oral antiplatelet drugs appeared,which ticagrelor plays the most important role.PLATOstudies[1]have confirmed that ticagrelor can significantly reduce the primary end point event rate compared with clopidogrel,while no significant increase in bleeding events.But the PLATO study included Chinese patients with limited number,it is lack of evidence that ticagrelor is safe and efficacy to the people in China.The purpose of this study is to investigate the safety and efficacy of ticagrelor versus clopidogrel therapy in patients with STEMI.Objective:196 patients with STEMI in Cardiology,Xijing Hospital,patients were divided into clopidogrel group(n=100)and ticagrelor group(n=96).All patients received conventional treatment after admission.The clopidogrel group received loading dose 300 mg followed by standard dose(75 mg,1/day,orally).The ticagrelor group recieved 180 mg load dose followed by standard dose(90 mg,2/day,oral)treatment.1 month,3 months,6 months,12 months follow-up after hospital discharge was observed between the two groups.Patients with adverse outcome events and bleeding event rates were recorded.Results:The general condition of patients,risk factors,clinical medicine and other treatment were not statistically different(P> 0.05).12 months of primary and secondary endpoint events were not significant different between groups(P> 0.05).Major and minor bleeding events between the two treatment groups was not significantly different(P>0.05).Age subgroup:Primary endpoint events were not significant different between groups(P>0.05).Major and minor bleeding events between the two treatment groups was not significantly different(P>0.05).BMI subgroup:Primary endpoint events were not significant different between groups(P>0.05).BMI<24 group of patients were significantly higher than those of BMI?24 group with bleeding events(28.9%vs22.8%%= 24,P<0.01).Gender subgroup:Primary endpoint events were not significant different between groups(P>0.05).Major and minor bleeding events between the two treatment groups was not significantly different(P>0.05).Conclusion:The study failed to confirm ticagrelor compared with clopidogrel significantlyreduced the incidence of STEMI patients adverse events,and there is no significant difference in the rates of major bleeding events between the two treatment groups.In the subgroup,the patients in the BMI<24 group were significantly higher than those of BMI?24 group with bleeding events.