| Objective: To observe curative effect of ticagrelor on patients with acute ST segment elevation myocardial infarction(STEMI)and type2 diabetes mellitus undergoing primary percutaneous coronary intervention.(PCI)Methods: Continuously select 81 patients who were diagnosed as STEMI combined with type 2 diabetes mellitus after undergoing primary PCI in the Second Hospital of Hebei Medical University from Oct.2014 to Aug.2016.Among them there were 44 males and 37 females.They were randomly divided into two groups:clopidogrel group(n=40)and ticagrelor group(n=41).The first group was given a dose of Clopidogrel Hydrogen Sulfate 300 mg at admission,after surgery was given 75 mg QD.The second group was given ticagrelor 180 mg at admission,after surgery was given ticagrelor 90 mg BID.Both of the two groups were given aspirin 300 mg at admission,after surgery were given aspirin 100 mg QD.Recording and comparing the differences of baseline clinical characteristics.This surgery compared the efficacy of the two medicine by recording platelet aggregation rate before treatment and 2 hour,7days,1 month,and 6 months after taking medicine;recording left ventricular ejection fraction(LVEF)at admission and 1 month,6 months after PCI;recording left ventricular end-diastolic diameter(LVEDD)at admission and 1month,6 months after PCI;recording platelet count at admission and 1month,6 months after PCI;recording the major adverse cardiovascular events(MACE)and adverse reaction events in a period of 6 months after PCI;recording bleeding events in a period of 6 month;recording ST-segment resolution 1hour after PCI;recording balloon dilatation instantly TIMI at surgery between clopidogrel group and ticagrelor group.The package of SPSS21.0 was used for analyzing data,and P<0.05 was considered statisticallysignificant.Results:1 There was no significant difference between the two groups in sex,age,smoking history,hypertension history,family history,hemoglobin,low density lipoprotein levels,serum creatinine levels,glycated hemoglobin level,door-to-balloon time,onset-to-balloon time(P>0.05).2 The platelet aggregation rate(%): the platelet aggregation rate in clopidogrel group and ticagrelor group was 79.27±7.95 vs 77.27±7.63 separately before treatment,the date was not significantly different between the two groups(P>0.05).Two hours after taking medicine,the platelet aggregation rate in ticagrelor group was lower than clopidogrel group,they were 45.16±7.16vs61.11±7.12 separately(P<0.05).Seven days after taking medicine,clopidogrel group and ticagrelor group was 54.45±7.19 vs 44.70±6.65separately(P<0.05).One month after the treatment,significant difference was observed between clopidogrel group(56.14±7.39)and ticagrelor group(46.06±7.11)(P<0.05).Six months after taking the medicine,clopidogrel group and ticagrelor group was 55.19±7.42 vs 45.55±7.04 separately(P<0.05).The two groups after taking medicine both had significant decline in platelet aggregation rate(all P<0.05).3 ST-segment resolution 1hour after PCI and balloon dilatation instantly TIMI3 at surgery: the rates of ST-segment resolution 1hour after PCI and balloon dilatation instantly TIMI3 at surgery were different between clopidogrel group and ticagrelor group,and the rate in ticagrelor group was higher than clopidogrel group(P<0.05).In clopidogrel group and ticagrelor group,the rates of the former were 97.6%vs80%,and the latter were 92.7% vs75%.4 Ultrasonic Cardiogram: The LVEF was 49.03±8.38 in clopidogrel group at admission,whereas 48.66±8.61 in ticagrelor group,there were no significant difference between the two groups(P>0.05).One month after PCI,clopidogrel group and ticagrelor group was 52.89±8.47vs56.93±9.48separately(P<0.05).Six months after PCI,the level of LVEF in ticagrelorgroup(58.02±9.69)was significantly higher than that in clopidogrel group(53.34± 8.77)(P<0.05).The LVEF after PCI in both groups were significantly better than that at admission(P<0.05).The LVEDD in clopidogrel group and ticagrelor group were 54.16±7.24vs52.89±7.01 separately at admission,the data was no significantly different between the two groups(P>0.05).One month after PCI,clopidogrel group and ticagrelor group was 50.34±8.54vs46.60±8.28 separately(P<0.05).Six months after PCI,significantly difference was observed between clopidogrel group(49.86±8.29)and ticagrelor group(45.96±8.41)(P<0.05).And the LVEDD after PCI in both groups were significantly better than that at admission(P<0.05).5 Postoperative follow-up: The incidence of MACE is lower in ticagrelor group than that in clopidogrel group within 6 months after PCI,the result is significantly different(4.9%vs22.5%,P<0.05).In general,the rates of total bleeding were different in the 6 months after PCI between clopidogrel group and ticagrelor group(5.0%vs22.0%,P<0.05).There was no major bleeding case observed in two groups(P>0.05).There were 8 dyspnea cases in ticagrelor group,which was significantly higher than that in clopidogrel group(P<0.05).6 Platelet count: There was no significant difference between two groups at admission,one month after PCI and six months after PCI(P>0.05).Platelet count did not decline after operation(P>0.05).Conclusion:1 Ticagrelor showed a better effect on the platelet aggregation rate than clopidogrel,and could significantly reduce major adverse cardiovascular events within six months after PCI.2 Ticagrelor was beneficial to coronary no-flow,and can improve myocardial perfusion.3 Ticagrelor could improve cardiac function after PCI.4 Ticagrelor could increase the incidence of total bleeding,but did not increase the rate of major hemorrhage.Clinical application is relatively safe. |
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