Clinical Study Of Anti-thrombotic Regimen In Patients With ACS And Diabetes Mellitus Undergoing PCI

Background:Acute coronary syndrome(ACS)is a kind of severe cardiac crisis caused by coronary atherosclerotic plaque rupture and acute thrombosis in blood vessels,which leads to vascular obstruction.ACS therapy is based on percutaneous coronary intervention(PCI)and antithrombotic drugs,which have been shown to reduce the incidence of early and late cardiovascular events.Further increased use of PCI requires adequate antithrombotic therapy to reduce the risk of associated complications.Diabetes(diabetes mellitus DM)as a high risk of cardiovascular disease state,has proved related to high platelet reactivity and coagulopathy.Compared with non-diabetics,diabetics are at greater risk for cardiovascular complications and reoccurrence of atherosclerotic thrombotic disease.However,at present,there are few studies on relevant antithrombotic drugs for ACS patients with diabetes undergoing PCI,so the optimal antithrombotic scheme is still unclear.Objective:Patients diagnosed with acute coronary syndrome with diabetes mellitus and PCI in huaihe hospital of henan university from October 2017 to October 2018 were retrospectively analyzed.To study and analyze the effectiveness and safety of different antithrombotic regimens in clinical treatment.It helps clinical workers to improve their understanding of this disease and treatment plan,improve the quality of life of ACS patients with DM,and improve the prognosis.At the same time,it will provide data help for future research.Method:Patients diagnosed with acute coronary syndrome complicated with diabetes and successfully underwent PCI in huaihe hospital of henan university from October 2017 to October 2018 were collected as study subjects.The included 262 patients were consulted and recorded in detail according to the medical records of the department of cardiology,huaihe hospital,henan university.First of all,they were divided into four groups according to the antithrombotic drugs they used during hospitalization,which were bivaludine + tegrilol in group A(n=59).Bivaludine + clopidogrel(n=50)in group B;Normal heparin + tigrilol in group C(n=68);Normal heparin + clopidogrel in group D(n=85).After that,relevant clinical data were collected,including hospital number,gender,age,cerebral infarction history,hypertension history,smoking history and other general information.Fasting blood glucose,systolic blood pressure,diastolic blood pressure,total cholesterol,triglyceride,high-density lipoprotein(HDL),low-density lipoprotein(LDL),uric acid,creatinine,plasma prothrombin time(PT),activated partial thrombin time(APTT),hemoglobin,platelet,LVEF,postoperative TIMI blood flow grade and other clinical indicators.Major adverse cardiovascular events(MACE)and bleeding events occurred during hospitalization.To compare the differences in the incidence of MACE events and bleeding events during hospitalization in the four groups,and to evaluate the independent risk factors affecting MACE events.Use of statistical software for spss22.0,measurement data meet normal distribution,the(x + s)said,comparison between the two groups using independent sample t test,multiple sets of comparison between using analysis of variance,the data does not meet the normal distribution,the M(IQR are much less),said the group comparison between the rank and inspection,counting data,said by than or rate comparison between groups by chi-square test,Kaplan Meier-method is used to estimate survival between groups,caused by Logistic regression analysis the influence factors of MACE.Result:1.baseline data 4 way between clinical baseline data for a comparison: gender(P = 0.145),age(P = 0.135),history of cerebral infarction(P = 0.775),hypertension(P = 0.189),smoking(P = 0.059),fasting blood glucose(P = 0.327),systolic blood pressure(P = 0.130),diastolic blood pressure(P = 0.279),total cholesterol(P = 0.726),triglyceride(P = 0.275),high density lipoprotein(P = 0.192).There were no significant differences in low-density lipoprotein(P=0.132),uric acid(P=0.16),creatinine(P=0.813),PT(P=0.655),APTT(P=0.088),hemoglobin(P=0.22),platelet(P=0.841),cTn(P=0.117),LVEF(P=0.067)and TIMI blood flow grade after PCI(P=0.641).2.comparison of MACE events during hospitalization: the incidence of MACE events during hospitalization was analyzed among the four groups,and the conclusion was that there was no statistically significant difference in the incidence of MACE events between the four groups(P=0.061).Further analysis of the occurrence time of MACE among the four groups showed that there was no statistically significant difference between the groups(Logrank test,X2 =4.378;P=0.223),that is to say,there was no difference between the four groups in the occurrence time of MACE event.The survival function between the four groups is drawn based on the occurrence time of MACE events,and the conclusion is that there is no difference between the four groups in terms of survival function.3.Comparison of bleeding events between the four groups during hospitalization: no patients in the four groups suffered from severe bleeding.Therefore,statistical analysis was carried out on minor and minor bleeding between the four groups.The results of statistical analysis showed that the incidence of secondary bleeding was statistically significant among the four groups(P=0.02).Pairwise comparison was conducted on this basis,and the results showed that there were statistically significant differences between group A and group B,group A and group D,and there were no statistically significant differences between the other groups.That is,group A was more prone to bleeding events.4.Multivariate regression analysis of independent risk factors of MACE: by multivariate regression analysis,age,grouping and total cholesterol were the independent influencing factors of MACE.Means that the incidence of MACE events increases with age;The higher the total cholesterol value,the more likely the occurrence of MACE.Compared with group A,group B is more prone to MACE,which is 3.564 times more than group A.Conclusion:1.The antithrombotic regimens composed of the anticoagulant drugs heparin,bivastatin and the antiplatelet drugs clopidogrel and tigrilol did not increase the incidence of MACE in ACS patients with diabetes undergoing PCI.2.Patients with ACS combined with DM who underwent PCI were more likely to have bleeding events when using bivaludine combined with tigrilol,an anti-thrombotic regimen.3.Age,grouping and total cholesterol are independent influencing factors of MACE,indicating that the older the age,the more likely the occurrence of MACE;The higher the total cholesterol value,the more likely the occurrence of MACE.Compared with group A(bivarudine combined with tigrillo),group B(bivarudine combined with clopidogrel)was more likely to cause MACE events,and group B had 3.564 times more MACE events than group A.