A Comparative Study Of The Early Antiplatelet Effect And Clinical Efficacy Between Ticagrelor And Clopidogrel In Patients With Acute Myocardial Infarction And Direct PCI

Background and Objective With the improvement of living standards,the incidenceof Acute Myocardial Infarction(AMI)is increasing more and more.Emergency percutaneous coronary intervention(PCI)cansignificantly reduce mortality and improve prognosis.The double antiplatelet therapy,combined Aspirin with P2Y12 receptor antagonist,is the basic treatment of acute coronary syndrome,meanwhile can significantly reduce the incidence of severe cardiovascular adverse events in patients with AMI andbecome an effective drug guarantee after PCI.As a classic P2Y12 receptor antagonist,Clopidogrel becomes vasoactive medicine and exerts their antiplatelet effects after liver enzyme activation,with a slow onset.Due to the emergence of individual differences on the antiplatelet effect with the presence of genetic polymorphisms,metabolic pathways and other drugs to interact with each other,the antiplatelet status of Clopidogrel has been challenged in the clinical application.Ticagrelor,as a new generation of antiplatelet drugs,does not need liver metabolism.It directly inhibits adenosine two phosphate mediated platelet aggregation,has strong antiplatelet effect and quick onset.In the PLATO study,ACS patients were given the ticagrelor consecutively for 12 monthswithout increasing primary bleeding events,and the risk of cardiovascular death / myocardial infarction /stroke composite end event was significantly lower than clopidogrel,with a risk of16%.Based on the benefits of treatment for patients with ACS,guidelines at home and abroad recommend that ticagrelorshould beprior used for antiplatelet therapy in patients with ACS.But East Asian populations saw no further benefits in the PHILO study.PLATO pays more attention to the reduction in the occurrence of clinical events about ticagrelor.However,the research have not detected the platelet aggregation rate,andhave not fully demonstratedwhether the enhancement of antiplatelet effect with rapid onset of drug will lead to the reduction of clinical events.The detection of platelet aggregation function,due to the existing issuesincluding the immediacy detection,the diversity and complexity of detection means,has not yet been widely carried out on the detection of platelet aggregation rate in patients with AMI given antiplatelet drugs,the related detectionsabout taking ticagrelor are minimal.Through the analysis of the patients with acute myocardial infarction treated with clopidogrel and clopidogrel,including the detection of the onset time of ticagrelor and clopidogrel,the maximumrate of platelet aggregation,the follow-up of the changes of the cardiac structure and function,the statistics of the incidence rate of the adverse events and safety events,the study explores the difference of early antiplatelet effect between ticagrelor and clopidogrel in patients with acute myocardial infarction(AMI)and evaluatesboth two the clinical efficacy and security.Methods This study was a prospective,single-center,randomized controlled study.Inclusion criteria: admission diagnosis of acute myocardial infarction(Acute Myocardial,Infarction,AMI)and percutaneous coronary intervention,coronary artery implantation of drug-eluting stents,standard dual antiplatelet therapy.There are 173 patients in our hospital from January 2014 to December 2016 with acute anterior wall myocardial infarction undergoing emergency PCI and randomly divided into two groups:ticagrelor group(n=87)and clopidogrel group(n=86)? All patients received the maximum platelet aggregation rate testand the inhibition of platelet aggregation calculation when the time of immediately before taking the medicine,1h/2h/24 h after taking medicine and 7d after operation respectively,furthermore we need compare the ability of two drugs to inhibit platelet aggregation and the difference in onset time between patients at each time node,observethe peak value of the ST segment in the postoperative 2hand the peak value difference of CK-MB(creatine,kinase,isoenzyme-MB),givecardiac ultrasound examination of two groups of patients after 1weeks/1 month/3 months/6 months of operation,gauge the left ventricular end diastolic diameter(LVEDD)and the left ventricular ejection fraction(LVEF).The cardiovascular events and safety events of the two groups are followed up for half a year.The incidence of major / secondary adverse cardiovascular events and safety are compared between the two groups.Results Between the two groups,age,gender,the proportion of high blood pressure,smoking,previous history,the characteristics of angiography and percutaneous Coronary Intervention(PCI)were not significantly different(P>0.05).Emergency PCI treatment of acute anterior myocardial infarction in the antiplatelet effect: the maximum platelet aggregation rate in medication after 2h,24 h and postoperative 7d in ticagrelor group was significantly decreased,17.44 + 4.66,16.12 + 4.41 and 13.94 + 2.98 respectively,and was significantly lower than the corresponding clopidogrel group,43.09±4.16?42.21±4.60?41.88±3.40 respectively.The difference between the two groups was statistically significant(P<0.05).At these time points,IPA of ticagrelor group was higher in the clopidogrel group(P<0.05).The platelets number was not significantly different between the ticagrelor group and the clopidogrel group(on the day after the operation and 7 days after surgery)(P>0.05).AMI direct PCI treatment of patients with clinical observation,for the ticagrelor group,postoperative 2H ECG,ST segment drops >50% for 45 cases,is higher than the clopidogrel group 32 cases,the difference was statistically significant(P=0.033).The CK-MB peak value was 206 ±27.5U/L in ticagrelor group and 223.1 ± 23.4U/L in clopidogrel group,the difference between the two groups was statistically significant(P=0.035);Ticagrelor group after 1weeks of operation,the mean LVEDD was 54.88 ± 3.88 mm,clopidogrel group mean 56.09 ± 3.86mm;After six months of operation,ticagrelor group mean LVEDD value is51.35 ± 2.59 mm,clopidogrel group is 52.21 ± 2.67 mm,the datas of the two groups had significant difference(P<0.05);The LVEF(%)51.65 ± 4.60 mm in the ticagrelor group was higher than that of the clopidogrel group(47.94±3.95)at 1 weeks after the operation,and the difference was statistically significant(P=0.02).The LVEF(%)55.02 ± 3.84 mm in the ticagrelor group was higher in clopidogrel group(53.21 ± 5.87mm)after six months,and the difference was statistically significant(P=0.038);The main adverse events in cardiovascular events were not significantly different between the two groups(P=0.053),the secondary adverse events in the ticagrelor group were lower in clopidogrel group(P=0.018).While the incidence of bleeding complications in the two groups,the mild bleeding events of the ticagrelor group was 25.2% higher than that in the clopidogrel group(17.4%),and the difference was statistically significant(P=0.038).There was no difference in the incidence of major bleeding and small bleeding events,and there was no statistically significant difference in overall TIMI bleeding rate(P=0.05)Conclusion In patients with acute myocardial infarction PCI,compared with clopidogrel: 1.Ticagrelor can play a better ability to inhibit platelet aggregation;2.Ticagrelor has a better clinical effectiveness and good safety.