Clinical effect of ticagrelor on elderly patients undergoing primary percutaneous coronary intervention with ST segment elevation myocardial infarction and reasons for ticagrelor withdrawl
投稿时间:2016-06-07  修订日期:2016-06-30
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Key words:elderly  ticagrelor  acute myocardial infarction  percutaneous coronary
郭金成 首都医科大学附属北京潞河医院心内科 
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      【Abstract】Objective To evaluate the effect and safety of ticagrelor on elderly ST segment elevation myocardial infarction(STEMI) patients undergoing primary percutaneous coronary intervention (PCI).Methods Two hundred and forty consecutive elderly STEMI patients undergoing primary PCI in our hospital from November 2012to December 2014 were divided into ticagrelor group(n=94) and clopidogrel group(n=146).The Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow was assessed after primary PCI. The 30d and 12-month major adverse cardiac event (MACE) was compared between the 2 groups. Results. TIMI grade 3 flow was significantly higher in ticagrelor group than in clopidogrel group(90.5%vs 80.8%,P=0.024).The incidence of BARC definition bleeding type and dyspnea related to ticagrelor or clopidogrel was similar between the 2 groups (28.7% vs 24.0%, P=0.412; 12.8% vs 6.8%, P=0.121). Compared with clopidogrel group, The rate withdrawal or discontinuation of antiplatelet therapy was higher in ticagrelor group (78.7% vs 13.7%, P <0.001).The reasons for ticagrelor or clopidogrel withdrawal was mainly attributed to doctor’s preference, cost and severe dyspnea (50.0%vs 1.4%, P<0.001,12.8% vs1.4%, P<0.001,5.3% vs 0.7%, P=0.025).No significant difference was found in the rates of MACE between 2 groups during in hospital and 12 month following (5.3% vs5.5%, P=0.957; 8.5% vs8.9%, P =0.916). ConcIusion Ticagrelor can significantly improve TIMI 3 grade flow after primary PCI in elderly patients with STEMI and without an increase in the rate of BARC bleeding, the reasons for withdrawal and discontinuation of ticagrelor were doctor’s preference, cost and dyspnea.