Impact Of Loading Ticagrelor On Coronary No Reflow During Emergency PCI In Patients With Acute ST Segment Elevation Myocardial Infarction

Objective:To investigate the impact of oral loading ticagrelor on coronary no-reflow phenomenon(NRP)with acute ST segment elevation myocardial infarction(STEMI)during emergency Percutaneous coronary intervention(PCI).Method:A total of 122 acute STEMI patients who accepted emergency PCI treatment were enrolled from February 2015 to February 2017 at the Cardiology Departmemt of the Second Hospital of Hebei Medical University in this study.Based on the type of P2Y12 ADP inhibitor taken in the emergency department,patients were divided into two groups.There were 69 cases with 56 males and 13 females,age rangging from 22 to 81 years old(the average age was 59.61±12.59 years old)in the clopidogrel group.There were53 cases with 49 males and 13 females,age rangging from 22 to 82 years old(the average age was 56.21±12.36 years old)in the ticagrelor group.Patients in the clopidogrel group were treated with oral 300 mg clopidogrel before emergency PCI and were given Clopidogrel 75 mg per day after operation.While patients in the ticagrelor group were treated with oral 180 mg ticagrelor before emergency PCI and were given ticagrelor 90 mg twice a day after operation.All patients were given the treatment with the diferent dosage of nitrates,beta blockers,angiotensin converting enzyme inhibitors(ACEI)/angiotensin II receptor antagonists(ARB)and statins according to the patient's condition after operation.The baseline clinical characteristics and the following data were observed:(1)The difference of time from onset to reperfusion,infarction related artery,TIMI flow grade before and after PCI procedure,corrected TIMI frame count(CTFC),TIMI myocardial perfusion grade(TMPG),thrombus aspiration catheter and Tirofiban use,length ofstents,stent diameter,the incidence of no reflow phenomenon were recorded during operation.(2)The level of creatine kinase(CK),creatine kinase isoenzyme(CK-MB)and c Tn I was mensurated every 6 hours after onset and the peak of value was recorded.(3)Patient's platelet aggregation rate(the patients who were treated with tirofiban must stop application for more than 8hours)for postoperative 24 hours was recorded.Echocardiography results after postoperative 1 day were recorded.(4)The incidence of adverse clinical events during were observed hospitalization.All clinical data were analyzed with SPSS 21.P Value of less than 0.05(2-tailed)was considered to be statistically significant.Results:1 Comparison of baseline data between the two groupsThere was no significant difference in baseline characteristics,including age,gender distribution,smoking history,hypertension,diabetes,dyslipidemia history,preoperative systolic blood pressure,diastolic blood pressure,heart rate,Killip grade,previous myocardial infarction history,previous PCI history,site of myocardial infarction between two groups(P >0.05).There was no significant difference in blood glucose,serum potassium,total cholesterol,low density lipoprotein cholesterol,creatinine,platelet count,white blood cell count,serum BNP level and hs CRP between the two groups(P > 0.05).2 The parameters related to PCI in two groups patientsThere was no significant difference patients on the time from onset to reperfusion,infarction related artery,stent diameter,stent length,cases of preoperative and postoperative TIMI3 and TMPG3 blood flow,thrombus aspiration catheter and Tirofiban use the amount of contrast agent in Two groups(P > 0.05).The ratio of no reflow(9.4%vs.15.9%,P=0.29)in the ticagrelor group were lower than those in the clopidogrel group after operation.The difference was no statistically significant.The postoperative 24 hours platelet aggregation rate(28.05±15.66 vs.37.96±20.09,P=0.003)in the ticagrelor group were significantly lower than those in the clopidogrel group.3 Differences of myocardial enzymesThe peak value of CK(2512±820.4U/L vs.2678±1428U/L,P=0.45),CK-MB(290±91.6U/Lvs.292±106.7U/L,P=0.91),c Tn I(75.26±31.81ug/ml vs.80.1±32.33ug/ml,P=0.66)in ticagrelor group were higher than those in the clopidogrel group.The difference was no statistically significant.4 The results of echocardiography after postoperative 24 hoursThe left ventricular ejection fraction in ticagrelor group(55.18±7.83 vs.54.83±7.30,P=0.801)was higher than that in clopidogrel group.There was no significant difference.The left ventricular end diastolic diameter(52.04±4.70 mm vs.53.07±4.90 mm,P=0.023)was lower than that in clopidogrel group(P < 0.05).The difference was no statistically significant.5 The comparison of incidence of adverse clinical events during hospitalizationThere were 6 cases of gingival bleeding,1 case of heart failure in ticagrelor group.While there were 3 cases of bleeding events,2 cases of heart failure in clopidogrel group.The difference was no statistically significant(P > 0.05).The ratio of dyspnea in ticagrelor group(0.136 vs.0.016,P=0.01)was higer than the case in clopidogrel group.The difference was statistically significant.ConclusionTo some extent Ticagrelor can reduce the occurrence of NRP during emergency PCI operation.