| Objective：Coronary artery heart disease (CHD), refers to the occlusionor stenosis of the coronary artery, which leads to myocardial ischemia andhypoxia or necrosis. The most common reason for CHD is the severeatherosclerosis and coronary functional change (spasm). In our country,although the morbidity of CHD is inferior to the Europe and America but inrecent years, with the general improvement of people’s living standard and thegrowth of the unhealthy lifestyle, the numbers of coronary heart diseaseshowed a trend of increase year by year. Research shows that, thecardiovascular disease (CVD) patients in our country are at least230millionpresently (within2million patients were myocardial infarction), and therewere more than500thousand newly myocardial infarction (MI) occurred peryear. So the CHD has become one of the most common diseases in ourcountry. Acute coronary syndrome (ACS), which is a severe and acute clinicalevent in cardiovascular disease, is a serious threatening to people’s life.Meanwhile, diabetes is a high risk factor of CHD, and the vasculopathy havefeatures of multiple, diffuse and high restenosis rate in diabetes. So, thepatients with both ACS and diabetes have become the emphasis and difficultyin treatment.Percutaneous Coronary Intervention (PCI) is now widely used in clinicalas a key way for the treatment of CHD and it has a distinctive feature ofminimal trauma, high safety, quick recovery and shorter hospitalization time.But intra-stent thrombosis and restenosis after PCI was the problem needed tobe resolved. Studies have shown that the platelet activation and aggregationplays a key role in intra-stent thrombosis and restenosis，therefore use ofantiplatelet drugs preoperative and postoperative is particularly important.Clopidogrel in combination with aspirin is now the current standard therapy of PCI postoperative antiplatelet, but the triple antiplatelet therapy (Clopidogrelcombine with aspirin and cilostazol) has been paid attention and researchedgradually. Our study aims to discuss the curative effect and safety of tripleantiplatelet therapy by compares the platelet function of the two kinds ofantiplatelet therapies in treating ACS patients with diabetes after PCI, thenprovide more basis for the clinical application of cilostazol.Methods：From October,2012to October,2013, a total of60patientswith ACS combined diabetes that treated in No.2Affiliated hospital of Hebeimedical university were evaluated in our study. The patients’ diagnosisincluding unstable angina pectoris, acute non-ST segment elevationmyocardial infarction and ST-segment elevation myocardial infarction, and allpatients were diagnosed with type2diabetes. A coronary angiogram was usedin all cases to ensure they has the indication of PCI before the stentimplantation. Patients were divided into triple antiplatelet therapy group anddual antiplatelet therapy group randomly. All groups were given the treatmentof300mg aspirin and300mg clopidogrel before PCI, then switch to themaintenance treatment of aspirin100mg/day and clopidogrel75mg/day.Coronary angiogram and PCI was done during hospitalization. The tripletreatment group was given the antiplatelet therapy of aspirin100mg/day,clopidogrel75mg/day and cilostazol100mg bid, while the dual treatmentgroup with no cilostazol. Blood sample were collected before PCI, in7daysand30days after PCI, determining P-selectin and platelet aggregation rate(PAR), and major adverse cardiac events (including all-cause mortality,acutemyocardial infarction,recurrent angina) and hemorrhage events weremeasured.Results：1No strong correlation existed in the age, gender, vasculopathy, smoking,family history, hypertension, hyperlipidemia and blood tests (P＞0.05).2No statistically significant difference was found in the comparison ofP-selectin [(7.77±2.54)%vs.（7.96±2.75）%， P=0.79] and PAR[(41.52±5.06)%vs.(40.33±3.61)%, P=0.299] within pre-operation in two 3The expression percentage of P-selectin in dual and triple treatmentgroup within7days after PCI were (5.66±1.46)%and (3.72±1.89)%. Theexpression percentage of P-selectin declined within7days compared2h afterPCI, and there had a statistically significant difference (P＜0.05) in drop-outvalue. The P-selectin expression percentage in dual and triple treatment groupwithin30days after PCI were (3.85±1.59)%and (2.99±1.74)%, respectively,and were declined when compared with the value before PCI. The comparisonof the expression percentage of P-selectin between two groups within7daysafter PCI shows that, the declining in triple treatment group was more obviousthan dual treatment group [(3.72±1.89)%vs.(5.66±1.46)%,P=0.001], and thisdifference existed in30days after PCI [(2.99±1.74)%vs.(3.85±1.59)%,P=0.049].4The expression percentage of PAR in dual and triple treatment groupwithin7days after PCI were (28.89±6.31)%and (24.80±5.09)%. Theexpression percentage of PAR declined within7days compared before PCI,and there had a statistically significant difference (P＜0.05) in drop-out value.The PAR expression percentage in dual and triple treatment group within30days after PCI were (24.57±3.89)%and (21.48±4.44)%, respectively, andwere declined when compared with the value before PCI. The comparison ofthe expression percentage of PAR between two groups within7days after PCIshows that, the declining in triple treatment group was more obvious than dualtreatment group [(24.80±5.09)%vs.(28.89±6.31)%,P=0.008], and thisdifference existed in30days after PCI [(21.48±4.44)%vs.(24.57±3.89)%,P=0.006].5We found a statistically significant difference in comparison of tripleand dual treatment group in MACE within3months (0%and17%,respectively, P=0.026), while no difference was found in hemorrhage eventsbetween two groups (17%and10%, respectively, P=0.353).Conclusion：Triple antiplatelet therapy after PCI can inhibit plateletactivation and aggregation more effectively when caompared with dual antiplatelet therapy in patient with both ACS and diabetes, reducing theincidence of3-months MACE events and does not increase the risk ofbleeding. |
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