Comparing The Efficacy And Risk Of Bleeding Betweenticagrelor And Clopidogrel On Patient With Acute STEMI With Diabetes Mellitus

BackgroundIn the spectrum of disease in current society, the morbidity and mortality of coronary heart disease increases graduatelly in the current years and to be a serious threat to human health. Acute ST elevation myocardial infarction(ASTEMI) is one of the most common conditions, it is serious and has a high mortality. Diabetes mellitus is a most common chronic metabolic diseases nowdays, due to factors of high blood sugar, insulin resistance, dyslipidemia, chronic inflammation and abnormal platelet activation, vascular atherosclerosis of diabetes patients accelerated compared with non-diabetes patients, and coronary heart disease are more likely to be formed. The mortality and prognosis of acute STEMI with diabetes is worse than those of non-diabetic patients. Emergent percutaneous coronary intervention(PCI) are widely used in patients with acute STEMI and has saved many patients lives. Several guidelines advise dual antiplatelet therapy with aspirin and clopidogrel conventional to be used in patients with coronary heart disease and post-PCI patients. But we see many patients still have attack of cardiovascular events while given conventional double-antiplatelet therapy in clinical work. The phenomenon are more common in patients with diabetes mellitus. Ticagrelor is a novel antiplatelet drug with rapid onset, no metabolism by the liver, without affecting of gene polymorphism and strong antiplatelet effects and other advantages clopidogrel irreplace. PLATO study confirmed that ticagrelor can reduce the incidence of cardiovascular events significantly, without increasing the incidence of major bleeding events. Ticagrelor is recommended to be applied to clinical in a number of guidelines recently. But patients to be chosen in the PLATO study are most from other countries, only including 416 Chinese patients, account for 2.23 percentages of the total. The efficacy and safety of the drug for Chinese people who are low-body weight is inconclusive, there are still few studies in this area. And we observe that the risk of bleeding in ticagrelor group is higher than clopidogrel group in clinical. ObjectionThis research observes the aggregation rate of platelet, the incidence of major cardiovascular events and the risk of bleeding at several set times after acute STEMI and underwent emergency PCI patients with diabetes given clopidogrel or ticagrelor seperately. Thus, we can make sure the efficacy and safety of ticagrelor to Chinese people and provide a theoretical foundation for future clinical work. MethodsChoosing 203 patients of acute STEMI with diabetes and have emergency PCI. Patients were divided into group A and B according to the hospital admission card number. Group A contains 100 cases and taken 600 mg clopidogrel at a draught, then 75 mg daily. Group B contains 103 cases and taken 180 mg ticagrelor at a draught, then 90 mg bid. Patients of two groups are given aspirin 300 mg, atorvastatin calcium 40 mg and enoxaparin 1mg/kg immediately after diagnosis and tirofiban 10ug/kg via intracoronary bolus during the surgery, then 0.15 ug / kg.min via intravenous infusion in the later 36 h. Platelet aggregation rate were tested before and after treatment at about 0.5h, 2h, 24 h, 7d, 30 d and 3, 6, 9,12 months. Observing major cardiovascular events and the incidence of bleeding at 7d,30 d,3, 6,9 and 12 months after PCI. Results1. Clinical data including sex, age, underlying diseases, smoking history, family history, and other vascular lesions have no statistically significance between two groups(P> 0.05).2. The platelet aggregation rate between two groups has no significant difference before take drugs(P> 0.05). The platelet aggregation rate of ticagrelor group is significantly lower than clopidogrel group and all have significant difference(P <0.05);3. The major cardiovascular events and the incidence of angina of patients with acute ST elevation myocardial infarction and diabetes mellitus in ticagrelor group at one year time point is significantly lower than ticagrelor group and has statistical significance(P <0.05). But the incidence of cardiac death and myocardial infarction have no significant difference(P> 0.05);4.The incidence rates of overall bleeding, major bleeding, minor bleeding, slight bleeding of patients with acute ST elevation myocardial infarction and diabetes mellitus in ticagrelor group at one year increase significantly with clopidogrel group, the results are statistically significant(P <0.05),But the incidence of fatal bleeding has no significant difference(P> 0.05). Conclusions1. The antiplatelet effect of ticagrelor is stronger than that of clopidogrel;2. Comparing with clopidogrel, ticagrelor can reduce the rate of major cardiovascular events and angina at one year of patients with ST segment elevation myocardial infarction and diabetes mellitus, but there has no significant difference in the rate of cardiac death and myocardial infarction between two groups;3. Comparing with clopidogrel, ticagrelor can increase the risk of bleeding at one year of patients with ST segment elevation myocardial infarction and diabetes mellitus, including the overall bleeding, major bleeding, minor bleeding and slight bleeding. But the risk of fatal bleeding has no significant difference.