| Part I Ticagrelor in Acute ST Segment Elevation Myocardial Infarction after Emergency Percutaneous Coronary Intervention(PCI): Anti-platelet,Anti-inflammatory and Protecting Vascular EndotheliumObjectiveTo investigate the effect of ticagrelor on anti-platelet,anti-inflammatory and protecting vascular endothelial cells in patients with acute ST segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI),as well as the clinical prognosis and associated bleeding risk.Providing a theoretical basis on selecting effective anti-platelet drugs and reasonable drug dose to guide clinical medicine further.Methods193 patients who were admitted to the Xuzhou Center Hospital between December 2013 and May 2015 for acute STEMI with the procedure of PCI and met the inclusion criteria were continuously enrolled.There were 104 males and 89 females included.These patients were randomly divided into the ticagrelor group(case group,97 patients)and the clopidogrel group(control group,96 patients)according to the administration of ticagrelor or clopidogrel during the therapy.The related indexes of coronary intervention(the related indicators of myocardial infarction,criminal vascular perfusion and stent thrombosis rate after PCI)were observed between the two groups.The related indicators of thrombelastography(TEG),hypersensitive C-reactive protein(hs-CRP),Interleukin-6(IL-6),endothelial cell-specific molecule-1(ESM-1)and efficacy endpoint(ischemic endpoint and safety endpoint)were also observed.Results 1.No significant difference had be found between the case group and the control group in the infarct position,infarct related blood vessel position,coronary artery opening time,pressure at maximum balloon dilatation,stent length and diameter and TIMI risk score(P >0.05).2.Compared with the control group,the incidence of TIMI grade III blood flow in the case group was significantly increased(P<0.05).There were no significant statistical difference in TIMI 0-II grade blood flow rates(P>0.05)and CTFC in the anterior descending artery,circumflex artery,right coronary artery were statistically significant differences(P<0.05).3.The incidence of stent thrombosis in the case group was lower than that in the control group,but there was no significant difference in the incidence of acute stent thrombosis or sub-acute stent thrombosis(P>0.05).There was no significant difference in total stent thrombosis rate either(P>0.05).4.In the case group and the control group,the platelet inhibition rate of the ADP pathway(ADP%)increased significantly and the aggregation rate(MAADP)was significantly reduced at 2 hours and 7 days after administration.The difference was statistically significant(P<0.05).There was no statistically significant difference among the other indexes(P>0.05).5.In the ticagrelor group,the level of ADP% was significantly increased and the level of MAADP was significantly decreased at 2 hours after taking medicine in TIMI III group than in TIMI0-II group.The differences were statistically significant among the two groups(P<0.05).Compared with the the level of TEG at 7th day after taking medicine,the the level of TEG before taking medicine was no statistically significant difference(P>0.05).6.The level of hs-CRP,IL-6 and ESM-1 in the study group and the control group were not statistically significant difference at admission(P>0.05).The three indicators were all significantly increased at 24 hours after taking medicine,and the two groups have statistically significant difference(P<0.05).The level of hs-CRP,IL-6 and ESM-1 decreased on the 4th and 7th day after taking medicine,and the two groups were statistically different(P<0.05).7.The level of ESM-1 increased with the increase of hs-CRP and IL-6,and there was a positive correlation between ESM-1 and hs-CRP(r=0.523,P<0.001).A positive correlation was also found between ESM-1 and IL-6(r=0.431,P<0.001).8.No statistically significant difference was found between the case group and the control group in the incidence of ischemic endpoints(cardiac death,nonfatal myocardial infarction,need for emergency coronary revascularization,and stroke)and safety endpoints(bleeding events)within 30 days(P>0.05).Conclusion1.Ticagrelor has better effects on anti-platelet,anti-inflammatory and protecting vascular endothelial cells in patients with acute ST segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI)than clopidogrel.2.Ticagrelor can reduce the occurrence of non-slow and re-flow phenomenon than clopidogrel.TEG can be used to evaluate the efficacy of antiplatelet drugs so as to predict prognosis and guide the clinical medication.3.ESM-1,a new biological marker for endocrine function disorder,can be used as a new index to evaluate the severity and prognosis of coronary artery disease in patients with acute STEMI.It can also be a simple,effective,and practical method for the clinical evaluation of risk stratification in patients with acute STEMI.4.The incidence of ischemic endpoints in STEMI patients after PCI within 30 days is lower in the ticagrelor group than in the clopidogrel group while the incidence of safety endpoints is converse.But there is no significant statistical difference in both of them(P>0.05).It indicated that the clinical application of ticagrelor is safe.Part ? The Effect of Short-term Application of PPIs or H2 RA on Patients with Acute STEMI Treated with Ticagrelor after Emergency PCIObjectiveTo explore the effect of short-term application of PPIs or H2 RA on patients with acute STEMI treated with ticagrelor after emergency PCI.To provide reliable clinical drug test basis on whether ticagrelor combined with PPIs or H2 RA can prevent gastrointestinal bleeding and whether the combination increases the risk of ischemic events,so as to find a new,economical,effective and safe treatment way.MethodsAffiliating the patients of the ticagrelor group in the first part,170 patients who were admitted to the Xuzhou Center Hospital for acute STEMI with the procedure of emergency coronary angiograph(CAG)and PCI until September 2016 were continuously enrolled.90 males and 80 females were included.These patients were divided into the PPIs group(A group)which included pantoprazole group(A1 group,39 patients)and omeprazole group(A2 group,43 patients),the H2 RA group(B group,ranitidine group,43 patients)and the control group(C group,45 patients without PPIs or H2RA)according to the administration of PPIs or H2 RA during the therapy.The related indexes of coronary intervention(the related indicators of myocardial infarction,criminal vascular perfusion and stent thrombosis rate after PCI)were observed between the two groups.P-Selection(CD62P),platelet membrane glycoprotein IIb/IIIa(GP?b/?a),Creatine Kinase Isoenzyme-MB(CK-MB),cardiac troponin I(c Tn I),TEG and efficacy endpoint(ischemic endpoint and safety endpoint)were also observed.Results1.There were no statistically significant differences in the TIMI blood flow grade,corrected TIMI frame(CTFC)and the rate of stent thrombosis after PCI in each group(including the sub-group of A group).2.No significant difference was found in the level of platelet activation(CD62P,GPIIb / IIIa)at admission among each group(including the sub-group of A group)(P>0.05).CD62 P and GPIIb / IIIa both increased significantly at the 24 th hours after taking medicine,but there was no significant difference among each group(P>0.05).In addition,they both decreased significantly at the 7th day after taking medicine,but there was no significant difference among each group either(P>0.05).3.There was still no significant difference of ADP% and MAADP among each group when they are at admission,the 24 th hours and the 7th day after taking medicine(P>0.05).No significant difference of the above indicators among the sub-group of A group,B group and C group was found either at time nodes above(P>0.05).4.The level of typical myocardial necrosis markers(CK-MB,c Tn I)and BNP were not statistically different at admission among each group(including the sub-group of A group)(P>0.05).All of the three markers increased significantly at the 24 th hours after taking medicine and decreased significantly at the 7th day after taking medicine.There was no significant difference among each group(P>0.05).5.There was no significant difference in the incidence of ischemic endpoints within 30 days among each group(including the sub-group of A group)(P>0.05).However,the incidence of gastrointestinal bleeding was not the same in all groups in the safety endpoints(P<0.05).After comparison,the incidence of gastrointestinal bleeding in A group was lower than in C group and the difference was statistically significant(P<0.05).When compared A group with B group,there was no significant difference(P>0.05).The same situation was also found in B group and C group(P>0.05).The subgroup of A group and B,C two groups had no statistically significant difference(P>0.05).No significant difference was found in the incidence of other organ bleeding events among each group(including the sub-group of A group)(P>0.05).Conclusion1.The short-term application of PPIs or H2 RA combined with ticagrelor neither reduce the anti-platelet effect of ticagrelor nor increase the incidence of no / slow reflow events in patients with acute STEMI after emergency PCI.2.The short-term application of PPIs or H2 RA combined with ticagrelor does not cause new myocardial damage and cardiac function in patients with acute STEMI after emergency PCI,which means the short-term application of PPIs or H2 RA is safe.3.The short-term application of different PPIs or H2 RA combined with ticagrelor can reduce the risk of gastrointestinal bleeding and does not increase the incidence of ischemic events in patients with acute STEMI after emergency PCI.The new treatment way is safe and effective. |
PDF Full Text Request