A Comparative Study Of Ticagrelor And Clopidogrel In Patients With ST-segment Elevation Myocardial Infarction Intended For Primary Percutaneous Coronary Intervention

Objective : Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is essential for the patients with acute ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Owing to the “East Asian Paradox” phenomenon,East Asian populations have a lower risk of ischemia and a higher risk of bleeding than Caucasian.We evaluated the effectivity and risk of ticagrelor inhibiting platelet aggregation in acute STEMI patients intended to PPCI,analyzed and compared the differences in bleeding and ischemic events between two antiplatelet agents in patients with acute STEMI after primary PCI.Methods:A total of 1275 patients with STEMI intended for primary PCI were enrolled in Xiangyang NO.1 People Hospital from January 2015 to July 2019.The included patients were assigned into two groups by random number table method,the ticagrelor(T)group and clopidogrel(C)group,and both groups continued medication for at least 12 months.Bleeding events in the two groups were evaluated according to PLATO criteria and Bleeding Academic Research Consortium(BARC)criteria.The primary safety endpoints were clinically bleeding at 12 months.The secondary efficacy endpoints were major adverse cardiovascular events(MACE)at 12 months.Outpatient and telephone and telephone follow-up were performed after discharge for at least 1 year.Quantitative data statistical description of the application `c±S(normal distribution)or M(Q)(skewness distribution);the statistical description of qualitative data calculates the relative number(constituent ratio or rate).SAS 9.3 software was used for statistical analysis.Results:1.Baseline data comparison: Baseline data of the two groups were basically balanced.Seventy-nine patients did not meet the inclusion criteria.A total of 18 patients were diagnosed with myocardial infarction with non-obstructive coronary arteries(MINOCA)after coronary angiography.Fifty-one cases were lost to follow-up in both groups.2.The primary safety endpoints comparison: There were 71 cases of clinical bleeding events in ticagrelor group,compared with 46 cases in clopidogrel group(PLATO criteria).The incidence of clinically bleeding was significantly higher in the ticagrelor than the clopidogrel group(11.2% vs 7.2%:HR 1.62,95%CI 1.12-2.34,P=0.011).The risk of major and minor bleeding was also higher in ticagrelor group,and only 3 cases of fatal bleeding were found in group T.3.Comparison of secondary efficacy endpoints : There were 40 major adverse cardiovascular events in group T,and a higher risk of ischemic events in group T compared with 39 in group C(6.3% vs 6.1%:HR 0.82,95%CI 0.65-1.14,P=0.073).There were no significant differences in the risk of nonfatal myocardial infarction,stroke,revascularization,or defined stent thrombosis events between the two groups.Conclusion:1.Compared with clopidogrel,DAPT with standard-dose ticagrelor as compared with clopidogrel was associated was a significantly higher risk of bleeding in patients with acute STEMI after primary PCI.2.Ticagrelor has a limited benefit in reducing MACE occurrence compared with clopidogrel in STEMI patients after primary PCI.