| Objective:To evaluate the clinical efficacy and safety of ticagrelor in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention(PCI).Methods :Consecutive 324 STEMI patients undergoing primary PCI were randomly divided into group ticagrelor 1(n =116)and clopidogrel 1(n =208).Two groups continued to take medicine for at least 1 year.Platelet aggregation was detected before taking the drug.According to the result of platelet aggregation rate tested by turbidimetric method after treatment for 5d,the group clopidogrel was divided into group not high platelet reactivity(n =156)and group high platelet reactivity(n =52).Patients in group high platelet reactivitywas classified as the ticagrelor 2(n =168)were given ticagrelor instead of clopidogrel.Recording the results of platelet aggregation rate,and the incidence of MACE events and adverse drug reactions,and analyze related biochemical indicators and left ventricular ejection fraction.To analyze the changes of platelet aggregation before and after the substitution of high platelet reactivity group.Logistic regression was used to analyze the multivariate analysis of cardiovascular events after direct PCI of STEMI patients with the lipid metabolism disorder,age,platelet aggregation rate,complex lesions and LVEF.The survival curves were compared between two groups without incident survival rate by kaplan-meier method(log-rank test).Results:1.There were 168 cases in ticagrelor 2 group,110 males and 58 females,aged 48 to 79 years old with the average age 55.71± 8.23.There were 156 cases group clopidogrel 2,106 males and 50 females,aged 50 to 80 years old with an average age of 56.23± 7.94.2.Results of platelet aggregation test:The platelet aggregation rate was significantly after oral ticagrelor lower than clopidogrel;The platelet aggregation rate of high platelet reactivity group decreased significantly after replacement of ticagrelor(64.52±10.32 vs 25.42±7.85,P=0.000).3.Related biochemical indicators test results.There was no significant change in liver function before and after administration in two groups(P>0.05).In tearms of The creatinine and uric acid,ticagrelor 2 group was higher than clopidogrel 2 at follow-up 1 month,3 months,(P<0.05),but there was no significant difference at 6 months of follow-up(P>0.05);The levels of CK-MB were significantly lower after the two groups of drugs than before the drugs.At the same time,the ticagrelor 2 group was lower than the clopidogrel 2 group.4.Comparison of echocardiography results: In terms of the long-term prognosis of cardiac ejection function,ticagrelor is superior to clopidogre.5.MACE event comparison results: Total adverse cardiovascular events in the ticagrelor 2 group were lower than those in clopidogrel 2 group.Followed up for 3 months and 6 months,in terms of angina,difference was statistically significant(P < 0.05);In terms of cardiac insufficiency,the reconstruction of target vascular,non-fatal myocardial infarction,cardiogenic death,stent thrombosis,there were no statistically differences between the two groups.7.Adverse drug reactions were compared:Bleeding events: The clopidogrel 2 group was significantly higher than that of the ticagrelor 2 group.Dyspnea:Ticagrelor 2 group was significantly higher than t clopidogrel 2 group.8.Logistic regression analysis display:The risk factors of adverse events in patients were age,lipid metabolism disorder,platelet aggregation rate,complex lesions,LVEF(<50%),The regression equation established is: MACE=1.620* age +0.037* lipid metabolism disorder+0.775* platelet aggregation rate+1.124* complex lesions+1.259*LVEF(<50%)?9.The ROC area under the curve of MACE events was predicted by the level of platelet aggregation:0.810(95%CI: 0.759 ~ 0.860,P = 0.000),sensitivity and specificity are respectively are 92.5%? 62.5%?10.The survival curves were compared between two groups without incident survival rate by kaplan-meier method(log-rank test).The results showed that the median survival time was 5.851(5.735-5.968)in tigerelor group,and 5.654(5.378-5.750)in clopidogrel,the difference was statistically significant.Conclusions:1.In patients with STEMI undergoing direct PCI,tigerelor and clopidogrel can reduce platelet aggregation in patients.In contrast to clopidogrel,the antiplatelet action is more significant in the tigerelor.Tigerelor can treat patients with high platelet reactivity.2.Tigerelor and clopidogrel can increase the risk of bleeding and dyspnea,but adverse reactions are mild,and most occur at the beginning of the medication.The adverse reactions induced by tigerelor can be eliminated immediately after withdrawal.However,the adverse reactions caused by clopidogrel should be removed after a period of withdrawal.3.In patients with STEMI with direct PCI,effective and rational individualized antiplatelet therapy can significantly reduce the incidence of MACE.Tigerelor is more effective than clopidogrel to prevent adverse cardiovascular events in patients,... |
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