The Effect Analysis Of Ticagrelor On Patients Treated By Percutaneous Coronary Intervention With Acute Myocardial Infarction

ObjectiveThrough exploring the effect of antiplatelet therapy by using Ticagrelor on myocardial cell injury,liver and kidney function,platelet aggregation rate in 24 hours and the rates of in-stent restenosis(ISR),major adverse cerebral cardiovascular events(MACCE),bleeding events after 6 months in the patients with acute myocardial infarction(AMI)treated by percutaneous coronary intervention(PCI).Analysis the correlation between Ticagrelor and the prognosis of the patients,providing a new basis for the using of ticagrelor in the patients undergoing PCI with AMI.MethodsReview and collect 408 cases diagnosed as acute myocardial infarction in cardiovascular internal medicine department of our hospital had successful PCI.According to the use of drugs,patients were randomly divided into two groups:(ticagrelor group n=210)and(clopidogrel group n=198).The first part:according to the method of randomization,100 cases were selected from each two groups,as the observation group(ticagrelor group)and the control group(clopidogrel group).CK-MB,cTn I,ALT,Cr and platelet aggregation rate were collected before and 24 hours after PCI.All patients in the two groups were followed 6 months post-PCI for ISR,MACCE and bleeding events.The second part:All of the 408 cases were divided into the low risk group(GRACE<108 n=102),the middle risk group(109>GRACE?140,178)and the high risk group(GRACE>140 n=128),according to the results of the GRACE score.Analyses and compares the ISR,MACCE and bleeding events rate in 6 months post-PCI in the three groups.ResultsThe first part:There were no statistical differences between the observation group and the control group,such as the general condition,clinical treatment,coronary angiography and PCI data.The CK-MB,cTn T,Cr and platelet aggregation rate before PCI had no significant difference.The CK-MB(2.22±10.04ng/ml vs 3.87±0.06ng/ml,P=0.025),cTnT(0.013±0.003ng/ml vs:0.029±0.005ng/ml,P=0.000),Cr(109.11±6.32?mol/L vs:122.54±7.80?mol/L,P=0.034),and platelet aggregation rate(43.32±11.42%vs:57.21±13.32%,P=0,023),24 hours after PCI,had significant difference.The ALT had no significant difference between two groups,before or 24 hours after PCI.The observation group had significantly lower ISR,MACCE and bleeding events rate than the control group(P<0.05).The second part:There were no statistical differences in general conditions,clinical treatment of medication data,coronary angiography and PCI in the thee groups.The follow-up results of 6 months after PCI in two groups show that:There were no statistical differences in ISR and MACCE rate between the ticagrelor treated cases and clopidogrel treated cases,in the low risk and the middle risk group;But,the ticagrelor treated cases had lower bleeding events rate compared with the clopidogrel treated cases in this two groups.In the high risk group,the ticagrelor treated cases had significantly lowers in the ISR(7.43%vs 12.56%P=0.009),MACCE(6.67%vs 11.76%P=0.018)and bleeding events rate(5.00%vs 10.29%P=0.011)compared with the clopidogrel treated cases.ConclusionTicagrelor can decrease the platelet aggregation rate rapidly,protect myocardial 24 hours after PCI and reduce the incidence of postoperative within 6 months of ISR,MACCE and bleeding events rate in the acute myocardial infarction patients undergoing PCI compared with clopidogrel.Further more,ticagrelor have more validity and safety than clopidogrel in the high GRACE score cases.