Effect of ticagrelor in patients with multivessel coronary artery disease after percutaneous coronary intervention
LI Xiao-xia
LIU Hao
YAO Chao-ran
Abstract：Objective To investigate the effect of ticagrelor on patients with multivessel coronary artery disease(CAD)after percutaneous coronary intervention(PCI)for acute myocardial infarction(AMI).Methods A total of 156 patients with AMI and multi-vessel lesions were selected from February 2021 to February 2023,and were divided into the conventional group(78 cases)and study group(78 cases)according to random number table method.The conventional group was given clopidogrel before PCI,and the study group was given ticagrelor before PCI.The cardiac function indexes[left ventricular end-diastolic volume index(LVEDVI),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume index(LVESVI)],myocardial microcirculation indexes[right coronary artery frame number(RCA CTFC),left anterior descending branch frame number(LAD CTFC),left circumflex branch frame number(LCX CTFC),myocardial damage indicators[creatine kinase isoenzyme(CK-MB),cardiac troponin Ⅰ(CTn-Ⅰ)],platelet aggregation rate,Wnt/β-catenin pathway related genes(Wnt mRNA,β-catenin mRNA),inflammatory markers and the incidence of MACE 6 months after surgery were compared between the two groups.Results The LVEDVI and LVESVI of the study group were lower than those of the conventional group at 30 days after the surgery[(55.34±5.24)ml/m2 vs.(65.79±6.32)ml/m2,(32.63±2.74)ml/m2 vs.(36.22±3.38)ml/m2],while the LVEF was higher than that of the conventional group[(57.32±4.25)％vs.(52.65±3.49)％,with statistically significant differences(P＜0.05).At 7 days after the surgery,the RCA CTFC,LAD CTFC and LCX CTFC in the study group were lower than those of the conventional group[(19.11±3.03)frames vs.(24.35±3.56)frames,(18.75±2.14)frames vs.(22.74±3.03)frames,(16.52±2.06)frames vs.(21.14±3.18)frames],with statistically significant differences(P＜0.05).The levels of CK-MB and CTn-Ⅰ in the study group were lower than those in the conventional group 24 hours after the surgery[(32.16±4.17)U/L vs.(45.23±5.39)U/L,(5.13±1.08)ng/ml vs.(7.68±1.23)ng/ml],with statistically significant differences(P＜0.05).The platelet aggregation rate in the study group was lower than that in the conventional group at 24 hours and 30 days after the surgery(P＜0.05).The levels of Wnt,β-catenin,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the study group were lower than those in the conventional group at 30 days after the surgery[(1.03±0.30)vs.(1.59±0.35),(2.06±0.37)vs.(1.12±0.33),(124.36±18.63)ng/ml vs.(164.79±24.78)ng/ml,and(20.28±3.32)ng/ml vs.(37.26±4.27)ng/ml],with statistically significant differences(P＜0.05).The incidence of MACE in the study group was lower than that in the conventional group 6 months after the surgery(2.56％vs.11.54％,P＜0.05).Conclusion Compared with clopidogrel,ticagrelor therapy before PCI has more significant platelet inhibition effect in AMI patients with multi-vessel lesions,which can improve cardiac function and myocardial microcirculation,alleviate myocardial injury and inhibit inflammatory response,and reduce the occurrence of MACE after PCI.The mechanism may be related to inhibiting the activation of Wnt/β-catenin pathway.
Keywords：Acute myocardial infarctionMultiple vessel lesionsPercutaneous coronary interventionTicagrelorClopidogrelMyocardial injuryCardiac function
Publication Date：2024-09-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 782-788 )