Effect of Clopidogrel vs Ticagrelor on Platelet Aggregation and Inflammation Markers After Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction
Effect of Clopidogrel vs Ticagrelor on Platelet Aggregation and Inflammation Markers After Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction
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氯吡格雷与替格瑞洛对经皮冠状动脉介入治疗ST段抬高型心肌梗死后血小板聚集和炎症标志物的影响
DOI：
10.1016/j.cjca.2018.08.024
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发表时间：
2018-12-01
影响因子：
6.2
通讯作者：
Yu, Bo
中科院分区：
文献类型：
--
作者：
Jiang, Zaixin;Zhang, Ruoxi;Yu, Bo
背景：急性冠脉综合征患者表现出一种已知的影响血小板聚集的炎症反应。我们旨在阐明ST段抬高心肌梗死(STEMI)经皮冠状动脉介入治疗(PCI)后炎症程度与抗血小板治疗效果之间的关系。方法：这项单中心的回顾性研究包括203例接受直接经皮冠状动脉介入治疗的STEMI患者，并根据入院时的抗血小板治疗进行分层(氯吡格雷与替卡格雷)。根据冠状动脉介入治疗前高特异性C反应蛋白水平的分布，将炎症水平定义为低、中、高。住院期间和随访期间的血小板聚集功能被量化为透光性聚集仪上残留的二磷酸腺苷诱导的血小板反应性。结果：在中度和高度炎症状态下，氯吡格雷使用者残余的二磷酸腺苷诱导的血小板聚集率显著高于替卡格雷使用者。在氯吡格雷组中，3种炎症水平之间的血小板聚集功能差异有统计学意义。结论：在不同炎症水平下，替卡格雷对血小板的抑制作用均强于氯吡格雷，提示替卡格雷在全身炎症程度较高时可能具有更稳定的抗血小板作用。此外，替卡格雷与经皮冠状动脉介入治疗后随访时炎症指数的降低有关，这表明抗炎作用可能在抗血小板治疗中观察到的临床益处中发挥作用，这将为在接受直接经皮冠状动脉介入治疗的STEMI患者中使用替卡格雷提供额外的理由。
Background: Patients with acute coronary syndrome show an inflammatory response that is known to affect platelet aggregation. We aimed to clarify the relationship between the inflammation severity and the effect of antiplatelet therapy after percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).Methods: This retrospective, single-center study included 203 patients with STEMI who underwent primary PCI and were stratified on the basis of the antiplatelet therapy on admission (clopidogrel vs ticagrelor). Inflammation levels were defined as low, intermediate, and high, based on the tertiles of the distribution of high-specificity C-reactive protein levels pre-PCI. Platelet aggregation function during hospitalization and follow-up was quantified as residual adenosine diphosphate-induced platelet reactivity on light transmittance aggregometry. Inflammation markers were measured on admission and at 1 year post-PCI.Results: At intermediate and high levels of inflammation, residual adenosine diphosphate-induced platelet aggregation was significantly higher among clopidogrel users than among ticagrelor users. In the clopidogrel group, statistically significant differences in platelet aggregation function were observed among the 3 levels of inflammation. At 1 year post-PCI, ticagrelor users had significantly lower levels of interleukin-1 beta and higher levels of interleukin-35 and transforming growth factor-beta.Conclusion: At different inflammation levels, ticagrelor provides more potent platelet inhibition than clopidogrel, suggesting that ticagrelor might exert a more stable antiplatelet effect at higher levels of systemic inflammation. Furthermore, ticagrelor is associated with reduced indices of inflammation on follow-up after PCI, suggesting that anti-inflammatory effects might play a role in the clinical benefit observed with antiplatelet therapy, which would provide an additional rationale for using ticagrelor in patients with STEMI undergoing primary PCI.