Effect Of Ticagrelor On Myocardial Perfusion And Cardiac Function In STEMI Patients Undergoing Emergency PCI

Objective: This study was designed to evaluate the effect of ticagrelor on myocardial perfusion in patients with ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI)and heart function effects.Methods: A total of 123 consecutive STEMI patients admitted to hospital for emergency PCI were consecutively selected.They were randomly divided into ticagrelor group and clopidogrel group before operation,and the oral antiplatelet drug loading immediately after STEMI diagnosis was determined,and the intraoperative myocardial infarction thrombolysis was compared.Thrombolysis In Myocardial Infarction(TIMI)grade,corrected TIMI Frame Count(CTFC),TIMI myocardial perfusion grade(TMPG)was used to evaluate ticagrelor on myocardial perfusion,and follow-up observations of one-year comparison of ticagrelor on left ventricular ejection fraction(LVEF)in patients with STEMI.A comparative analysis of the effectiveness and safety of ticagrelor and clopidogrel.Results: A total of 123 STEMI patients were included in this study sample,divided into two groups according to the use of drugs: ticagrelor and clopidogrel groups,61 patients(47 males,mean age = 60.30 ± 11.56)and 62 patients(48 males,mean age = 58.89 ± 13.98).There was no statistical difference between the two groups in terms of general clinical data(mean age,gender,BMI,hypertension,diabetes,hyperlipidemia,smoking history,past MI,past PCI,past CABG).The duration of Door to balloon in ticagrelor and clopidogrel groups was 88.016±25.58 min and 80.377±23.73 min,respectively(P=0.079).The distribution of IRA in the two groups was 30 patients with STEMI in the ticagrelor group and 30 patients with LAD.LCX10 Cases,21 cases of RCA,27 cases of LAD in clopidogrel group,8 cases of LCX,and 27 cases of RCA(P=0.571,P=0.57,P=0.376);There were 23,17 and 21 patients with single vessel disease,double vessel disease and three vessel disease respectively,and 34,14 and 14 patients in clopidogrel group(P= 0.055).The comparison between the two groups of stents(the former is the average length of stent implantation,the latter The mean diameter of the implanted stents was 22.83±6.59 mm,2.90±0.36 mm in the ticagrelor group,22.74±4.66 mm in the clopidogrel group,and 2.93±0.34 mm in the clopidogrel group(P=0.282,P=0.772).There was no statistical difference between the two groups of arteries in angiography and PCI.There were 18 cases in ticagrelor group using tirofiban,12 in clopidogrel group,and no statistically significant difference(P=0.190).Compared with the Thrombus score of two groups,there was no significant difference between the two groups(P=0.386).During the operation,23 patients in the ticagrelor group underwent thrombus aspiration and 19 in clopidogrel group,with no significant difference(P=0.409).The preoperative TIMI blood flow classification of the two groups was compared.It was found that there was no significant difference in the distribution of TIMI blood flow between the two groups before operation(P=0.086).In patients with grade 3 TIMI blood flow after PCI,57 patients were in both groups(P= 1.000);There was no negative flow in 4 cases of ticagrelor group and 7 cases in clopidogrel group(P=0.358).There was no statistical difference between the above results.In the ticagrelor group,the overall CTFC was 16.71±5.321 and the clopidogrel group was 21.77±5.926(P<0.05).According to the IRA specific group,the CTFC between the ticagrelor group(LAD,LCX,RCA)was smaller than that of the clopidogrel.In the ticagrelor group,the differences were statistically significant(16.93±5.4 vs.21.91±6.152,P=0.002;14.05±2.192 vs.20.88±4.883,P=0.005;15.50±2.062 vs.20.22±4.154,P<0.05).There were 41 patients with TMPG3 in the ticagrelor group and 30 patients in the clopidogrel group after PCI.The difference was statistically significant(P<0.05).Through telephone and outpatient follow-up,the left ventricular ejection fraction of the ticagrelor group and the clopidogrel group increased in 1 years after PCI,and the improvement of ticagrelor group was more significant(P=0.043).The number of heart failure in all two groups decreased,and the number of the ticagrelor group decreased more significantly.The difference was statistically significant(P=0.041).During the 1-year follow-up period,there were 8 cardiac events in the ticagrelor group and 17 in the clopidogrel group(P<0.05).Overall,bleeding was more frequent in the ticagrelor group,but there were no statistically significant bleeding episodes in both cases.During the follow-up period,no severe arrhythmias occurred in 123 patients.Allergic reactions,shocks,and other adverse reactions to the drug components occurred.One patient in the clopidogrel group died of a ruptured heart.Among the patients,one case of dyspnea occurred in the ticagrelor group,and the degree was mild.The drug was not discontinued and improved after 2-4 days.Conclusion: 1 For STEMI patients undergoing emergency PCI,preoperative loading of ticagrelor can improve postoperative myocardial perfusion;2 After 1 year of follow-up,Ticagrelor group can significantly improve cardiac function in patients with acute ST-elevation myocardial infarction compared with Clopidogrel group;3 After 1 year of follow-up,the Ticagrelor group can reduce the incidence of MACE events,and no significant increase in bleeding risk,no other significant adverse reactions.