| Objective: This observational trial was designed to study the efficacy and security of loading ticagrelor to the treatment of acute ST segment elevation myocardial infarction before thrombolysis.Methods: This study selected consecutive patients who were treatmented in the fifth Cardiology Department in the Second Hospital of Hebei Medical University from December 2016 to December 2017.All of the patients were diagnosed with STEMI,and who had been given rhProurokinase thrombolytic therapy concurrent with emergency PCI.Patients admitted to hospital were divided into clopidogrel group and ticagrelor group according to different P2Y12 ADP receptor inhibitor before thrombolysis.Patients in the clopidogrel group were treated with clopidogrel 300 mg before rhPro-urokinase thrombolysis and maintained 75 mg per day after surgery.While patients in the ticagrelor group were treated with ticagrelor 180 mg before thrombolysis and were maintained 90 mg twice per day after surgery.Both groups were chewed at the same time with aspirin enteric-coated tablets300 mg prior to thrombolysis and 100 mg per day after surgery.All patients who were considered for thrombolytic recanalization were transferred to our emergency cath lab for emergency CAG within 3-24 hours,and scored for infarction related artery TIMI blood flow.Patients who did not achieve grade3 or reached grade 3 but had a fixed stenosis of more than 75% underwent emergency PCI.Those who failed to be thrombolytically transferred for the remedial PCI as soon as possible.The doses of beta-blockers,nitrates,ACEI/ARB and statins were adjusted according to the patient's condition.After admission,the following indicators were recorded in all selected patients: 1)General baseline data: gender,age,BMI,risk factors for coronary heart disease,admission to baseline laboratory parameters,preoperative systolicblood pressure,and heart rate,Killip classification and so on.2)Comparing the intra-operative data of two groups,including onset-thrombolysis time,thrombolysis-intervention time,TIMI flow of IRA before and after PCI,TMPG,CTFC,and the like are provided.3)CK,CK-MB,and cTnI were measured every 6 hours after onset and recorded the peak of the value.4)LVEF and LVEDD were measured by echocardiography within 24 hours after operation.5)Record the occurrence of bleeding events and MACEs during hospitalization.All statistical analyses were performed using the SPSS21.0 software package,and a bilateral P<0.05 was considered statistically significant.Results: This study included a total of 68 patients with 35 cases in the clopidogrel group(30 males,average age 55.23±12.44 years)and 33 cases in the ticagrelor group(28 males,mean age 57.55±9.59 years).1.General baseline datas of two groupsTwo groups of patients in the gender,age,BMI,high risk factors for coronary heart disease(including hypertension,diabetes,hyperlipidemia,smoking,etc.),the baseline laboratory indicators [white blood cell count,hemoglobin,platelet count,alanine aminotransferase,creatinine,serum potassium,total cholesterol,low-density lipoprotein cholesterol,BNP,systolic blood pressure,heart rate,and Killip classification were not statistically different(P>0.05).2.Interventional data and myocardial microcirculation related indicators in two groupsOnset-thrombolytic initiation time was 4.37±2.43 h in clopidogrel group,thrombolysis initiation-CAG time was 13.31±7.96 h,While the reperfusion time and thrombolytic initiation-CAG time was respectively 4.00±2.00 h and14.30 ± 7.24 h in ticagrelor group.There was no significant difference between the two groups.There was no significant difference in IRA distribution,proportion of three-vessel disease,average number of stents implanted,and dose of contrast.Compared with the clopidogrel group,the rate of TIMI 0 flow in the ticagrelor group showed a downward trend,and theproportion of the TIMI 3 flow showed an upward trend,but the difference was not statistically significant(20.0% vs.15.2% P=0.600;60.0% vs.66.7%,P=0.569).There was no significant difference in TIMI 2 flow and TIMI 3flow after PCI.Compared with the clopidogrel group,CTFC levels in the ticagrelor group after PCI were higher(34.00±4.68 vs.30.52±3.78,P=0.001),and the difference was statistically significant.Postoperative myocardial perfusion TMPG grade 3 in the clopidogrel group was lower than the ticagrelor group,and the difference was not statistically significant(80.0% vs.87.9%,P=0.151).3.Peaks of myocardial injury markers in both groupsThe CK,CKMB,and cTNI were measured every 6 hours in selected patients and the peak value was recorded.The results showed that the peak of myocardial injury markers in the ticagrelor group was lower than that in the clopidogrel group,but the difference was not statistically significant(Peak CK: 2671.43± 1423.88U/L vs.2387.30±1980.70U/L%,P=0.502;Peak CK-MB: 254.48±124.17U/L vs.234.75±201.20U/L,P=0.631;Peak cTn I:78.66± 26.14ng/ml vs.71.37±31.97ng/ml,P=0.328).4.Cardiac function in two groupsEchocardiography of all patients were underwent within 24 hours after operation.The LVEF and LVEDD were measured.The results showed that the cardiac function of patients in the ticagrelor group was better than that of the clopidogrel group.There were no significant differences in LVEF and LVEDD both between these patients.(LVEF: 53.65±6.53% vs.54.60±7.78%,P=0.588;LVEDD: 50.91±3.28 mm vs.49.21±4.67 mm,P=0.085).5.Bleeding adverse events and MACEs during follow-up in both groupsThere were 0 cases of major bleeding in the clopidogrel group and 1case in the ticagrelor group,while there were 4 cases and 3 cases in the minor bleeding group.There was no significant difference between the two groups.Cardiac deaths in the clopidogrel and ticagrelor groups were 1 and 0,respectively.The incidence of malignant arrhythmias in the two groups was 3and 2 respectively.The incidence of heart failure occurred in 6 cases and 3cases respectively.There were 1 case and 0 cases of nonfatal recurrent myocardial infarction in both groups.There was no significant difference in the incidence of MACE between the two groups(P>0.05).The proportion of dyspnea in the two groups was 1 in the clopidogrel group and 5 in the ticagrelor group.There was no statistical difference between the two groups(2.9% vs.15.2%,P=0.076).Conclusions:1.Chewing loading dose of ticagrelor before thrombolysis can increase the open rate of epicardial large vessels in patients with STEMI to a certain extent,and better improve the microcirculation of coronary arteries.2.Chewing loading dose ticagrelor before thrombolysis is not inferior to the clopidogrel in improving cardiac function for the STEMI patients,and does not significantly increase the risk of bleeding. |
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