Effect of prolonged ticagrelor on clinical outcomes in elderly patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention
Objective To investigate the effect of prolonged ticagrelor on clinical outcomes after percutaneous coronary intervention(PCI)in the elderly patients(age ≥65 years)with acute ST-segment elevation myocardial infarction(STEMI).Methods From February 2018 to February 2021,a total of 105 patients(aged ≥65 years)with acute STEMI were enrolled,who received dual anti-platelet therapy(DAPT)with ticagrelor plus aspirin(DAPT≥2)after PCI at the First Hospital of Qinhuangdao.On the basis of long-term use of aspirin,the patients were divided into the control group(n=37;ticagrelor for one year)and the observation group(n=68;ticagrelor over one year).The observation group was divided into two subgroups according to the dose of ticagrelor:observation group A(n=40;standard dose,90 mg/time,2 times daily)and observation group B(n=28;low dose,45 mg/time,2 times daily).The three groups were compared after emergency PCI in thrombolysis in myocardial infarction(TIMI)grade 3 blood flow,proportion of complete regression of electrocardiogram(ECG)signs,platelet function(MA)in thrombelastogram(TEG),adenosine diphosphate-induced platelet aggregation rate,and 1-year follow-up,including major adverse cardiovascular and cerebrovascular events(MACCE)and bleeding events.SPSS 25.0 was used to process the data,and t test and x2 test were used for comparison between groups.Results After PCI,the proportion of patients with TIMI grade 3 blood flow in the two observation groups was significantly higher than that in the control group(x2=4.699,4.353;P=0.030,0.036).At two years after PCI,the MA value and adenosine diphosphate-induced platelet aggregation rate on thromboelastography of the two observation groups were significantly lower than those in the control group(t=8.752,6.524;P＜0.001).After one year follow-up,there was significant difference in the incidence of MACCE among the three groups(x2=4.354;P=0.039).The incidence of MACCE in the two observation groups was significantly lower than that in the control group(x2=4.769,5.082;P=0.028,0.024),but there was no significant difference between the two observation groups.There was no significant difference in the incidence of bleeding events among the three groups.Conclusion Prolonged ticagrelor after PCI in the elderly(≥65 years old)STEMI patients(DAPT≥2 points)may reduce the incidence of MACCE,and low-dose(45 mg)ticagrelor does not increase the risk of bleeding,which needs to be further confirmed with long-term follow-up.
万方数据
维普
