Effects Of Load Ticagrelor/clopidogrel On TIMI Blood Flow And Prognosis In Patients With Emergency PCI

Objective : To investigate the effect of loading dose of ticagrelor or clopidogrel on coronary artery blood flow and prognosis in patients with acute ST-segment elevation myocardial infarction before emergency PCI.Methods:According to the inclusion and exclusion criteria,a total of 207 patients with ST-segment elevation acute myocardial infarction treated by emergency percutaneous coronary interventional in the department of Cardiology of ningxia medical university general Hospital from October 2017 to October 2018 were included in this retrospective study.According to the preoperative medication status,they were divided into ticagrelor group(n=113)and clopidogrel group(n=94).Aspirin 300 mg were both given two groups before operation,the patients in the ticagrelor group were given ticagrelor 180 mg and the patients in the clopidogrel group were given clopidogrel 600 mg.Record the general clinical data of the selected cases,such as smoking or alcohol consumption,hypertension,diabetes,cardiac function(Killip classification)at admission,length of hospital stay,lipid profile,biochemistry and myocardial injury markers at admission,etc.Record relevant blood test indicators,such as blood routine,coagulation function,hypersensitive CRP before and after emergency PCI and postoperative thromboela-stogram.The relevant examination conditions after PCI were included in detail,such as echocardiography markers and Electrocardiogram:STR.Coronary blood flow related indicators were recorded,the TIMI and TMPG grades were compared between the two groups of patients and the postoperative TIMI grades of the two groups of patients were further stratified according to the risk degree,age,and whether they werecombined with diabetes.The major adverse cardiovascular events(including cardiac death,ischemic stroke,acute left heart failure,target vessel revascularization,recurrent angina,malignant arrhythmia,nonfatal myocardial infarction)and bleeding events(including major bleeding events,secondary bleeding events,minor bleeding events).during hospitalization were collected in detail.Comprehensive analysis and comparison of the effects of two antiplatelet drugs on coronary blood flow and prognosis.Results:(1)There was no significant difference between the two groups of patients in the general clinical data,such as age,body mass index(BMI),history of hypertension or diabetes,gender,smoking or drinking,hospitalization days,cardiac function,homocysteine(HCY),blood lipid,biochemical routines,myocardial enzymology(P>0.05).(2)At discharge,the white blood cell count and platelet count in the ticagrelor group were lower than those in the clopidogrel group,and the difference was statistically significant(P<0.05).At discharge,the mean platelet volume of ticagrelor group was higher than that of clopidogrel group(P<0.05).(3)At discharge,the prothrombin time(PT)in the ticagrelor group was higher than that in the clopidogrel group(P<0.05).At discharge,the fibrinogen quantification(FIB)and D2 polymer in the ticagrelor group were lower than those in the clopidogrel group(P<0.05).(4)The postoperative inhibition rate of ADP pathway in ticagrelor group was higher than that in clopidogrel group(P<0.05).The postoperative MAADP value of ticagrelor group was lower than that of clopidogrel group(P<0.05).(5)the postoperative 2hSTR regression rate in the ticagrelor group was better than that in the clopidogrel group(P<0.05).(6)The postoperative TIMI grading,TMPG grading,postoperative TIMI grading in the high-risk group,postoperative TIMI grading in the elderly group,and postoperative TIMI grading in the diabetes group were all higher than those in the clopidogrel group(P<0.05).(7)There was no significant difference in the occurrence of major cardiovascular adverse events and bleeding events during hospitalization between the two groups(P>0.05).Conclusion:1.The inhibition rate of platelet ADP pathway in ticagrelor group was higherthan that in clopidogrel group.2.TIMI blood flow and TMPG grading in ticagrelor group after emergency PCI were better than those in clopidogrel group,and the same trend was observed in high-risk,elderly and diabetic subgroup.3.There was no difference in the occurrence of major cardiovascular adverse events and bleeding events during hospitalization between ticagrelor and clopidogrel groups.