Influence Of Ticagrelor And Clopidogrel On Inflammatory Biomarkers For STEMI Patients Receiving Emergency Percutaneous Coronary Intervention

ObjectiveComparison of the influence of ticagrelor and clopidogrel on inflammatory hematological biomarkers red blood cells distribution width (RDW) for patients with acute ST-segment elevation myocardial infarction receiving emergency percutaneous coronary intervention in 24hours, lweek,30days after patients receiving PCI. To discuss the difference between the anti-inflammatory effect of ticagrelor and clopidogrel.MethodsFor inclusion in the study the subject should fulfill the following criteria:a) Age≥ 18 years old and<80 years old. b) Consecutive patients who should be hospitalized with documented evidence of STEMI receiving PCI. c) All patients have persistent≥ 0.2 mV ST-segment elevation in two or more contiguous precordial leads or≥ 0.1 mV ST elevation in two or more contiguous limb leads, with one of the following:persistent chest pain or elevation of biomarkers of myocardial necrosis, d) Time from chest pain onset to receiving PCI<12 h. e) Persistent chest pain<12 h. Subjects should not enter the study if any of the following exclusion criteria are fulfilled:a) Involved in other trials.b) In last year have P2Y12 receptor antagonist drug treatment history or long-term use of immunosuppressive agents.c) Recurrent myocardial infarction or previous history of CABG surgery or rescue PCI.d) Active bleeding or bleeding history.e) Obvious infection and body temperature (axillary temperature) higher than 38.0 ℃.f) Autoimmune diseases.g) Malignancies.h) In last 6 months have received major surgery.i) Left ventricular ejection fraction is less than 30%. Enrolled patients were randomly assigned to receive a loading dose of ticagrelor 180 mg as the treatment group or clopidogrel 600 mg as the control group. After PCI, the treatment group will be treated with ticagrelor 90 mg twice daily while the control group will be treated with clopidogrel 75 mg once daily. RDW was detected 24hours,1 week,1 month after the treatment respectively. Blood and urine and stool routines, PT,APTT, blood glucose, blood lipid, troponin T and liver and kidney functions were tested before and after the meditation. All the patients were observed in terms of symptoms, cardiovascular events and adverse reactions.ResultsThe 2 groups patients had no statistic difference of RDW in emergency blood tests and 24hours after PCI (emergency:p=0.563; 24hours:p=0.139).And there was no significant statistic difference of RDW in 1 week after PCI (p=0.446). The significant result happened in 30days after PCI on RDW lever (p=0.013), The group clopidogrel had lower RDW than the group ticagrelor:12.90 (1.80) vs 13.90 (1.65).Conclusion1. Ticagrelor and clopidogrel had no difference in 24hours and 1week hematological inflammation-related indicators RDW in patients receiving emergency percutaneous coronary interventional therapy for acute ST-elevation myocardial infarction.2.In 30days after receiving PCI,the RDW of clopidogrel group is lower than the ticagrelor group. And clopidogrel had better anti-inflammatory effect than ticagrelor.