Impact of different doses of ticagrelor on adverse reactions and serum indexes levels in patients with myocardial infarction after percutaneous coronary intervention

CAO Li-bo; HAN Li-ping; YANG Hao-yu; JIA Dong-li

doi:10.3969/j.issn.1672-5301.2025.02.007

Abstract：Objective To investigate the effects of different doses of ticagrelor on adverse reactions and disease-related serum indicators in patients with myocardial infarction after percutaneous coronary intervention(PCI).Methods A total of 186 patients with myocardial infarction who underwent PCI in our hospital from January 2021 to January 2023 were selected and randomly divided into the convention dose group(n=93)and the low dose group(n=93)according to a random number table method.The conventional dose group was treated with conventional dose ticagrelor(90 mg/time),while the low dose group was treated with low dose ticagrelor(45 mg/time).The cardiac function[left ventricular end-systolic diameter(LVESD),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD)],coronary flow-related indicators[diastolic peak flow velocity(DPV),coronary time velocity integral(CTVI),coronary flow velocity reserve(CFVR),systolic peak flow velocity(SPV)],platelet function[arachidonic acid-induced maximum platelet aggregation rate(AA-MAR),maximum platelet aggregation rate(MPAR),adenosine diphosphate-induced maximum platelet aggregation rate(ADP-MAR)],disease-related indicators {serum soluble intercellular adhesion molecule(sICAM-1),lipoprotein a[Lp(a)],soluble vascular cell adhesion molecule(sVCAM-1),calprotectin A4(S100A4)},major adverse cardiovascular events(MACE)and bleeding events were compared between the two groups.Results After 3 months of treatment,the LVEF in the conventional dose group was significantly larger than that in the low dose group[(57.32±1.24)％vs.(54.79±1.09)％,P＜0.05].The LVESD and LVEDD were significantly smaller than those in the low-dose group(32.29±1.39)mm vs.(36.83±1.58)mm,(50.13±2.35)mm vs.(54.36±2.54)mm,P＜0.05].However,there was no significant difference between the two groups after 6 months of treatment(P＞0.05).After 3 months of treatment,the DPV,CTVI,CFVR and SPV in the conventional dose group were significantly higher than those in the low dose group[(34.18±2.16)cm/s vs.(30.56±1.82)cm/s、(23.05±1.45)vs.(19.74±1.39)、(3.49±0.32)vs.(3.02±0.30)、(16.81±1.06)cm/s vs.(14.76±1.00)cm/s,P＜0.05];but there was no significant difference between the two groups after 6 months of treatment(P＞0.05).After 3 months of treatment,the AA-MAR,MPAR and ADP-MAR in the conventional dose group were significantly lower than those in the low dose group(P＜0.05);and there was no significant difference between the two groups after 6 months of treatment(P＞0.05).After 3 months of treatment,the levels of serum sICAM-1,Lp(a),sVCAM-1,and S100A4 in the conventional dose group were significantly lower than those in the low-dose group[(387.25±16.58)μg/L vs.(425.63±21.36)μg/L、(196.25±14.94)mg/L vs.(224.76±17.66)mg/L、(247.07±10.15)μg/L vs.(258.64±12.32)μg/L、(38.98±5.25)ρg/ml vs.(47.42±6.72)ρg/ml,P＜0.05];but there was no significant difference between the two groups after 6 months of treatment(P＞0.05).There was no significant difference in the incidence of MACE between the two groups(P＞0.05).The total incidence of bleeding events in the conventional dose group was higher than that in the low dose group(13.48％vs.4.49％,P＜0.05).Conclusion Treatment with different doses of ticagrelor after PCI for myocardial infarction can improve cardiac function and platelet function,increase the coronary blood flow and alleviate disease progression.With the extension of treatment time,low dose ticagrelor can also achieve similar effects as conventional doses,without significantly increasing the incidence of MACE and with a low risk of bleeding.Therefore,the dosage should be selected based on the specific circumstances in clinical practice.