Effect Of Different Administration Times Of Ticagrelor Before Primary Percutaneous Coronary Intervention On Reperfusion Effect In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective:To observe the effect of different administration time of ticagrelor before primary Percutaneous coronary intervention(PCI)on reperfusion effect in patients with ST-segment elevation myocardial infarction(STEMI).Methods:STEMI patients who underwent primary PCI in Hunan People’s Hospital from December 2019 to December 2020 were continuously collected and were divided into two groups according to the time interval between the administration of ticagrelor loading dose and balloon dilation.General clinical data,coronary angiography and echocardiography data were collected to compare myocardial reperfusion effect and cardiac function.Every study participant completed one-month and three-month follow-up.Major adverse cardiovascular and cerebrovascular events(MACCE),including stent thrombosis,reinfarction,revascularization,all-cause mortality,stroke and clinical related bleeding events,were compared between the two groups.Results:1.Comparison of baseline data: There was no significant difference in general data(age,gender,weight,blood pressure,etc)between the two groups(P>0.05).2.Comparison of myocardial ischemia and reperfusion: The time from onset of chest pain to balloon dilation(S-to-B),the time from first medical contact to balloon dilation(FMC-to-B),and the time from entrance to the hospital to balloon dilation(D-to-B),there was no significant difference between the two groups(P>0.05).The corrected TIMI frame count(CTFC)was significant between the two groups(P<0.05);there were no significant difference in TIMI blood flow before and after PCI and ST-segment resolution(STR)(P>0.05).3.Comparison of cardiac function: There were no significant difference in left ventricular end diastolic diameter(LVEDD)and left ventricular posterior wall(LVPW)between the two groups(P>0.05).ΔLVEF and ΔWMSI represented the difference of left ventricular ejection fraction(LVEF)and wall motion score index(WMSI)between two groups before discharge and at admission,and there was significant difference between the two groups(P<0.05).4.The results of univariate analysis showed that CTFC was correlated with different administration time of ticagrelor,ischemia time,degree of stenosis,body weight,hyperlipidemia,systolic blood pressure and other factors(P<0.05).5.By the multiple regression model stratification adjustment for multiple factors analysis,after adjusting for age,gender,weight,diabetes mellitus,degree of stenosis and history of hyperlipidemia,the results shown in grouping according to the different ischemia time,different administration time of ticagrelor on CTFC was statistically significant(P<0.05).The values were 0.144,0.149,0.044 respectively in the groups with ischemia time less than 3 hours,between 3 hours to 6 hours and more than 6 hours.6.Follow-up results: There were no significant difference in the occurrence of MACCE compound end points,independent end points and clinically related bleeding events between the two groups during the 3month follow-up(P>0.05).The incidence of stent thrombosis in the two groups was 2.2%(1/46)and 3.2%(2/62);the incidence of reinfarction was 0.0%(0/46)and 3.2%(2/62);the incidence of revascularization was2.2%(1/46)and 6.5%(4/62);the incidence of all-cause mortality was2.2%(1/46)and 3.2%(2/62).There were no stroke events in both groups.The incidence of major bleeding events in the two groups was 2.2%(1/46)and 0.0%(1/62);the incidence of moderate bleeding events was 0.0%(0/46),6.5%(4/62);the incidence of minor bleeding was 17.4%(8/46)and 11.3%(7/62).Conclusion:1.Pretreatment for ticagrelor within 90 minutes before primary PCI in STEMI patients can improve the reperfusion outcome,the left ventricular ejection fraction and ventricular wall motion score index.2.The effect of reperfusion after primary PCI was correlated with ischemia time and the different administration time of ticagrelor;the time of administration before operation was proportional to the CTFC when the ischemia time was less than 6 hours;the effect of administration time on reperfusion was weakened when ischemia time was longer than 6hours.3.The ischemia time was less than 3 hours,the time of administration ticagrelor was prolonged by 1 minutes,the CTFC increases by 0.144 frames;the ischemia time was between 3 hours and 6hours,the time of administration ticagrelor was prolonged by 1 minutes,the CTFC increased by 0.149 frames;when the ischemia time was more than 6 hours,the time of administration ticagrelor was prolonged by 1minutes,and the CTFC increased by 0.044 frames.