| Objective:To investigate whether ticagrelor and clopidogrel have different effects on QT dispersion(QTd)and inflammatory factors hs-CRP and sCD40 L during the perioperative period and 1 month after percutaneous coronary artery stent implantation(PCI)in patients with acute coronary syndrome(ACS),respectively,so as to guide clinical rational and scientific drug selection.Methods: 69 ACS patients who received PCI treatment in our hospital were randomly selected.Randomized number table method was used to divide the control group into 34patients(clopidogrel group: preoperative loading dose 300 mg,postoperative 75mg/ time,1 time/day,to 1 year after the operation)and the experimental group into 35 patients(ticagrelor group: preoperative loading dose 180 mg,postoperative 90mg/ time,2times/day,to 1 year after the operation).Both groups were treated with aspirin(preoperative loading dose of 300 mg,postoperative loading dose of 100mg/ time,once/day,to 1 year after the operation)with Dual antiplatelet therapy(DAPT).Routine12-lead ECG examination was performed 24 hours before surgery,24 hours after surgery and 1 month after surgery,QTd value was calculated.Venous blood samples were taken to measure hs-CRP and sCD40 L.Ischemic events,bleeding events and malignant arrhythmias were followed up half a year after surgery.Results:QTd values of the control group and the experimental group were significantly shorter 24 hours after surgery and one month after surgery than those of 24 hours before surgery,P <0.05,and the difference was statistically significant.The QTd value at 1month after surgery in both groups was not significantly shorter than that at 24 hours after surgery,and the P value was >0.05,showing no statistical significance.QTd values of 24 hours and 1 month after surgery in both groups were significantly shorter than those of 24 hours before surgery in the experimental group(P <0.05),with statistically significant differences.The level of inflammatory factor hs-CRP in control group and experimental group was significantly increased 24 hours after surgery compared with 24 hours before surgery,with P value <0.05,and the difference was statistically significant.hs-CRP significantly decreased at 1 month after surgery compared with 24 hours after surgery,P <0.05,the difference was statistically significant.hs-CRP significantly decreased at 1 month after surgery compared with 24 hours before surgery,P <0.05,the difference was statistically significant.The hs-CRP levels of the two groups were compared in the degree of decrease1 month after surgery compared with 24 hours before surgery.The decrease was more significant in the experimental group,P <0.05,the difference was statistically significant.The level of inflammatory factor sCD40 L in control group and experimental group was significantly increased 24 hours after surgery compared with 24 hours before surgery,with P value <0.05,and the difference was statistically significant.sCD40 L significantly decreased at 1 month after surgery compared with 24 hours after surgery,P <0.05,the difference was statistically significant.sCD40 L significantly decreased at 1 month after surgery compared with 24 hours before surgery,P <0.05,the difference was statisticallysignificant.In terms of the degree of decline,the level of sCD40 L 1 month after surgery was compared with that 24 hours before surgery,and the P value was >0.05,showing no statistical significance.The results of half-year follow-up in control group and experimental group showed that there were 5 cases of ischemic events in control group and 4 cases of ischemic events in experimental group,with P value =0.9628,and the difference was not statistically significant.There were 5 bleeding events in control group and 4 bleeding events in experimental group(P =0.9628),and the difference was not statistically significant.There were 16 cases of malignant arrhythmias in the control group and 8 cases of malignant arrhythmias in the test group(P =0.031),and the difference was statistically significant.Conclusion:The perioperative application of ticagrelor or clopidogrel in PCI of ACS patients can shorten QTd and reduce the levels of hs-CRP,sCD40 L and other related inflammatory factors.and reduce the occurrence of malignant arrhythmia and sudden cardiac death.Ticagrelor can shorten QTd more than clopidogrel,and its effect on hs-CRP is greater than that of clopidogrel.In the perioperative period of PCI,the application of ticagrelor or clopidogrel can reduce postoperative complications such as stent restenosis and stent thrombosis,and significantly improve the prognosis.However,the effect of ticagrelor on sCD40 L was similar to that of clopidogrel without increasing bleeding events,and the prevention of ischemic events was even better than that of clopidogrel. |
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