Effects Of Different Antithrombotic Drugs On Changes Of PMA And Platelet CD40L In Patients With STEMI Before And After Emergency PCI

OBJECTIVE:To investigate the effects of different antithrombotic drugs on platelet activation and inhibition of inflammatory response in STEMI patients undergoing emergency PCI and to compare the effects of different drugs on adverse cardiovascular events and bleeding complications in patients with STEMI after PCIMETHODS:Sixty-eight patients with acute ST-segment elevation myocardial infarc-tion who underwent cardiovascular medicine at the Affiliated Hospital of Binzhou Medical College were selected as observation group,including 38 males and 30 females The observation group was divided into Group A,Group B and Group C according to the medication.Group A(aspirin+clopidogrel+tirofiban+heparin)includes 22 cases;Group B(aspirin+ticagrelor+bivalirudin)includes 21 cases;Group C(aspirin+ti-cagrelor+tirofiban+heparin)includes 25 cases.Fity-eight healthy subjects were se-lected as the control group.All medical records of the patients in the observation group were included in the cardiovascular department of the Affiliated Hospital of Binzhou Medical College including name,gender,age,onset time,history of hypertension,smoking history,drinking history,family history and past medical history.The percent-age of PMA and platelet CD40L in the STEMI patients before and after PCI were measured.The vascular grading of the patients in the observation group after PCI was recorded.The adverse cardiovascular events and bleeding complications were observed in the experimental group 30 days after dischargeRESULTS:The percentage of PMA and platelet CD40L in the observation group was significantly higher than the control group(P<0.05).There was a positive correlation between PMA,platelet CD40L and troponin I of STEMI patients(P<0.05).The per-centage of PMA and platelet CD40L in the observation group was significantly lower than that before operation(P<0.05).The percentage of PMA and platelet CD40L in Group C was significantly lower than Group A and Group B after 24 hours of PCI.The difference was statistically significant(P<0.05).Compared with the Group A,the myo-cardial perfusion rate of the C group was higher and the difference was statistically sig-nificant(?2=4.968,P=0.041).There was no statistically significant difference in myo-cardial perfusion between Group B and Group C(x2=1.217,P=0.457).Compared with Group C,the incidence of adverse cardiovascular events in Group A was higher within 30 days and the difference was statistically significant(x2=4.968,P=0.041).There was no significant difference in the incidence of events between Group B and Group C(?2=2.489,P=0.203).There was no significant difference in the incidence of bleeding complications between Group A and Group C(?2=1.396,P=0.328).Group B and group C bleeding was no significant difference in the incidence of complications(x2=0.859,P=0.543)Conclusion:In the perioperative period of PCI of STEMI patients,ticagrelor has stronger antiplatelet activation and inhibition of inflammatory reaction than clopidogrel and the incidence of adverse cardiovascular events is lower.Tirofiban and heparin has better antiplatelet activation than bivalirudin alone,but in the anti-inflammatory aspect,tirofiban and heparin is not as effective as bivalirudin alone.