Effects Of Ticagrelor On Platelet Parameters,Short-term Efficacy And Safety In Patients With STEMI Undergoing Primary PCI

Objective: To investigate the effect of aspirin combined with ticagrelor on platelet parameters,short-term efficacy and safety in patients with acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention(PCI).Methods: A total of 77 patients who were diagnosed as STEMI from September 2017 to June 2018 in the emergency department of HeBei General Hospital and agreed to undergo emergency PCI were randomly divided into two groups: ticagrelor group and clopidogrel group.There were 40 cases and 37 cases respectively.The changes of platelet parameters,including platelet count(PLT),platelet hematocrit(PCT),platelet distribution width(PDW)and mean platelet volume(MPV),were compared between the two groups before PCI and 7 days,30 days after PCI.The changes of cardiac function,including left ventricular ejection fraction(LVEF)and left ventricular end diastolic diameter(LVEDD),were compared between the two groups at 30 days after PCI.Adverse cardiovascular events(including recurrent angina pectoris,recurrent myocardial infarction,stroke,heart failure,cardiogenic death,Malignant arrhythmia)and drug safety(including hemorrhage,dyspnea)were recorded in two groups within 30 days after PCI.SPSS 21.0 statistical software was used to process the data of the indexes to be observed,and a bilateral P<0.05 was considered statistically significant.Result:1.Comparison of clinical data: There was no significant difference in gender,age,smoking history,hypertension,diabetes,dyslipidemia,previous stroke,hospital laboratory index(creatinine,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,triglycerides,white blood cells,neutrophils absolute value),regular medication(nitrate,angiotensin converting enzyme inhibitor/angiotensin receptor blockers,beta-blockers,Calcium channel blocker,statins,proton pump inhibitors) between the two groups.There was no significant difference in IRA distribution,TIMI flow before PCI,TIMI flow after PCI and intraoperative medication(P>0.05).2.Comparison of platelet parameters: The repeated measures ANOVA analysis showed that there were significant differences in MPV and PDW between the two groups(P=0.011,P=0.030),while the PLT and PCT had no significant difference(P=0.139,P=0.392).PCT,MPV and PDW had significant difference at different time points(P<0.001).There was no interaction between PLT,PCT and time in the two groups(P>0.05).There was interaction between MPV,PDW and time in the two groups(P<0.001,P=0.009).It indicated that that PLT and PCT showed the same change trend,while the trend of MPV,PDW is different with time.Further comparing the MPV and PDW levels at different time points in the two groups: the MPV and PDW of the two groups were both increased at 7 days after PCI compared with that before PCI,and the difference was statistically significant(P<0.05).The levels of MPV and PDW in two groups decreased at 30 days after PCI compared with 7 days after PCI,and the difference was statistically significant(P<0.05),but the levels of MPV in ticagrelor group decreased at 30 days after PCI compared with that before PCI(P<0.05),while the levels of MPV in clopidogrel group increased at 30 days after PCI compared with that before PCI,and the difference was statistically significant(P>0.05).The PDW in ticagrelor groups at 30 days after PCI was lower than that before PCI,and the difference was significant(P<0.05);while PDW in clopidogrel group increased at 30 days than before,the difference was significant(P<0.05).Comparison of MPV and PDW at different time points:There was no significant difference between the two groups in MPV and PDW levels before PCI(P>0.05),but the levels of MPV and PDW in ticagrelor group were lower than those in clopidogrel group at 7 days and 30 days after PCI(P<0.05).3.Comparison of cardiac function: 30 days after PCI,LVEF and LVEDD was improved in both groups compared with that before PCI,but there was no significant difference between the two groups(P>0.05)4.Comparison of cardiovascular adverse events 30 days after PCI: There was no cardiogenic death,recurrent myocardial infarction,stroke or malignant arrhythmias in the two group.The recurrence events of angina pectoris were 2 cases in the ticagrelor group,7 cases in the clopidogrel group,and 1 case and 2 cases of heart failure,respectively.There was no significant difference between the two groups(P>0.05).The total adverse cardiovascular events in the ticagrelor group were less than those in the clopidogrel group,and the difference was statistically significant(P=0.042).5.Compare two groups of drug safety: There were no major bleeding events in the two groups.There were 3 cases in the ticagrelor group and 1 case in the clopidogrel of smell bleeding,6 cases and 3 cases of minor bleeding,2 cases and 0 cases of dyspnea in the two groups,respectively.There was no significant difference between the two groups(P>0.05).Conclusion:Ticagrelor can better inhibit the changes of platelet parameters in patients with STEMI undergoing emergency PCI,thus affecting platelet activation.There was no significant difference between ticagrelor and clopidogrel in improvement of short-term cardiac function,but ticagrelor had better effect in reduced short-term adverse cardiovascular events.In terms of drug safety,there was no difference between ticagrelor and clopidogrel,and ticagrelor was generally safe and effective.