The Influence Of Different Antiplatelet Drugs On Contrast Acute Kidney Injury After Percutaneous Coronary Intervention In Patients With Acute Coronary Syndrome

Objective:To investigate the effect of different antiplatelet aggregation drugs on contrast acute kidney injury(CIAKI)in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention.Methods:143 patients who underwent coronary angiography(CAG)or percutaneous coronary intervention(PCI)who underwent acute coronary syndrome were randomly divided into two groups according to the random number table method: Ticagrelor treatment group(n=71),clopidogrel treatment group(n=72),both groups received other routine treatments after admission,the ticagrelor treatment group received a dose of 180 mg of ticagrelor before surgery.CAG and stent implantation(also known as PCI)were given a standard dose of 90 mg/time,2 times a day,Recorded as ticagrelor group(n=51).The clopidogrel treatment group received a preoperative clopidogrel load of 300 mg,CAG and stent implantation were given a standard dose of 75 mg/time,once a day,and recorded as clopidogrel(n=56).Ticagrelor and clopidogrel were discontinued after CAG alone.The control group(n=36)was discontinued,Statistical data of patients,preoperative,postoperative(24h,48 h,72h)serum creatinine(Scr),cystatin C(CysC).The estimated glomerular filtration rate(e GFR)was calculated and the incidence of CIAKI was estimated.Results:There were no significant differences in age,sex ratio,and underlying diseases among the three groups(P>0.05).There was significant difference in Scr between the three groups after operation for 48 h and preoperative and postoperative(24h,72h)(P<0.05).The average level of Scr was higher in the ticagrelor group and clopidogrel group.In the control group,the average level of Scr after the ticagrelor group was higher than that of the clopidogrel group;CysC 24 h after surgery in three groups was a statistically significant difference between the preoperative and postoperative 72 h CysC(P<0.05).CysC 48 h after surgery in three groups was a statistically significant difference between the preoperative and postoperative 72 h CysC(P<0.05).The average level of CysC in the ticagrelor group and clopidogrel group was higher than that in the control group,the average level of CysC in the ticagrelor group was higher than that in the clopidogrel group.There were significant differences in e GFR between the three groups at 48 h after operation and before and after(24h,72h)(P<0.05).The average level of e GFR in the ticagrelor group and the clopidogrel group was lower than that in the control group.The difference between CysC in the ticagrelor group and CysC in the control group was statistically significant(P<0.05).The difference between CysC in the clopidogrel group and CysC in the control group was statistically significant(P<0.05).There was an interaction between time and drug in the changes of Scr and CysC indexes(P<0.05).There was no significant difference in the incidence of postoperative CIAKI between the three groups(P>0.05).The incidence of CIAKI in the ticagrelor group was slightly higher than that in the clopidogrel group(5.88%,5.36%).Conclusion:Among patients with CAG or PCI,there was no significant difference in the incidence of CIAKI between the three groups.After the ticagrelor group,the renal function decreased and the incidence of CIAKI increased compared with the other two groups.Patients who need to use ticagrelor antiplatelet therapy should be able to protect renal function and prevent CIAKI treatment during the perioperative period.