Comparison of Efficacy between Clopidogrel and Ticagrelor in Patients with Acute Coronary Syndrome after Interventional Treatment and Their Effects on IL-6
Background: We aimed to compare the efficacy between clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and their effects on IL-6.
Methods: A retrospective analysis and collection of 200 ACS patients diagnosed by the Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China in 2016 were performed. Patients were randomly divided into clopidogrel group and ticagrelor group. Data of left ventricular ejection fraction and ACS clinical classification before PCI, PCI treatment, IL-6, platelet aggregation status, maximum platelet aggregation rate (MPAR), P2Y12 response unit (PRU) and adverse reaction of patients were collected. After PCI, patients were followed up for 1 year to compare the ischemia after treatment between clopidogrel group and tigravilol group.
Results: MPAR and PRU after PCI of clopidogrel group were significantly higher than those of ticagrelor group (P<0.05). The expression of IL-6 in two groups peaked at 1 day after PCI and then decreased. That of ticagrelor group was consistently lower than that of clopidogrel group (P<0.05). The incidence of ischemic events after treatment in clopidogrel group was significantly higher than that in ticagrelor group (P<0.001).
Conclusion: Compared with clopidogrel, tigerrilol had more significant inhibition of platelet aggregation after PCI in ACS patients, and tigerrilol had better effect after interventional treatment in ACS patients. In addition, compared with clopidogrel, tegrel can significantly inhibit the expression of IL-6 in patients with ACS and better alleviate the inflammatory response after PCI.
2. Roffi M, Patrono C, Collet JP, et al (2016). [2015 ESC Guidelines for the manage-ment of acute coronary syndromes in pa-tients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syn-dromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)]. Eur Heart J, 14;37(3):267-315. [Article in Chinese].
3. Damman P, van 't Hof AW, Ten Berg JM, et al (2017). 2015 ESC guidelines for the management of acute coronary syn-dromes in patients presenting without persistent ST-segment elevation: com-ments from the Dutch ACS working group. Neth Heart J, 25: 181-185.
4. Crea F, Liuzzo G (2016). Anti-inflammatory treatment of acute coronary syndromes: the need for precision medicine. Eur Heart J, 37: 2414-2416.
5. Cimmino G, Loffredo FS, Morello A, et al (2017). Immune-inflammatory Activation in Acute Coronary Syndromes: A Look into the Heart of Unstable Coronary Plaque. Curr Cardiol Rev, 13(2): 110–117.
6. Ikeda U, Ito T, Shimada K (2001). Interleu-kin-6 and acute coronary syndrome. Clin Cardiol, 24: 701-704.
7. Amos A, Newby LK (2005). Using bi-omarkers to assess risk and consider treatment strategies in non-ST-segment elevation acute coronary syndromes. Curr Cardiol Rep, 7: 263-269.
8. Crea F, Binder RK, Luscher TF (2018). The year in cardiology 2017: acute coronary syndromes. Eur Heart J, 39: 1054-1064.
9. Zhao Y, Li S, Ma L, Sun Y, Du X, Huo Y, Hu D, Gao R, Wu Y (2014). [A cross-sectional study of factors related to tradi-tional Chinese medicine use for hospital-ized acute coronary syndrome patients in China's level 2 hospitals]. Zhonghua Xin Xue Guan Bing Za Zhi, 42: 156-160. [Ar-ticle in Chinese].
10. Varenhorst C, Jensevik K, Jernberg T, et al (2014). Duration of dual antiplatelet treatment with clopidogrel and aspirin in patients with acute coronary syndrome. Eur Heart J, 35: 969-978.
11. Sahlen A, Varenhorst C, Lagerqvist B, et al (2016). Outcomes in patients treated with ticagrelor or clopidogrel after acute myo-cardial infarction: experiences from SWEDEHEART registry. Eur Heart J, 37: 3335-3342.
12. Wallentin L, Becker RC, Budaj A, et al (2009). Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 361: 1045-1057.
13. Mehta SR, Bassand JP, Chrolavicius S, et al (2010). Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med, 363: 930-942.
14. Walker CW, Dawley CA, Fletcher SF (2007). Aspirin combined with clopidogrel (Plavix) decreases cardiovascular events in patients with acute coronary syndrome. Am Fam Physician, 76: 1643-1645.
15. Berger JS (2013). Aspirin, clopidogrel, and ticagrelor in acute coronary syndromes. Am J Cardiol, 112: 737-745.
16. Uzel H, Ozpelit E, Badak O, Akdeniz B, Ba-ris N, Aytemiz F, Goldeli O (2014). Di-agnostic accuracy of mean platelet volume in prediction of clopidogrel resistance in patients with acute coronary syndrome. Anadolu Kardiyol Derg, 14: 134-139.
17. James S, Angiolillo DJ, Cornel JH, et al (2010). Ticagrelor vs. clopidogrel in pa-tients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLA-TO) trial. Eur Heart J, 31: 3006-3016.
18. Bartolomucci F, Tito A, Navarese EP, et al (2017). STEMI and NSTEMI ACS in a 30-Year-Old Patient: An Extremely Rare Complication of a Left Atrial Myxoma. Heart Surg Forum, 20: E116- E118.
19. Gotsman I, Lotan C, Soskolne WA, et al (2007). Periodontal destruction is associ-ated with coronary artery disease and per-iodontal infection with acute coronary syndrome. J Periodontol, 78: 849-858.
20. Zeymer U, Zahn R (2016). [Immediate mul-tivessel PCI in patients with ACS: Is less more?]. Herz, 41: 566-571. [Article in German].
21. Singh S, Molnar J, Arora R (2007). Efficacy and safety of bivalirudin versus heparins in reduction of cardiac outcomes in acute coronary syndrome and percutaneous coronary interventions. J Cardiovasc Phar-macol Ther, 12: 283-291.
22. Forst T, Wilhelm B, Pfutzner A, et al (2008). Investigation of the vascular and plei-otropic effects of atorvastatin and pioglitazone in a population at high car-diovascular risk. Diab Vasc Dis Res, 5: 298-303.
23. Zhang Y, Zhao Y, Pang M, Wu Y, Zhuang K, Zhang H, Bhat A (2016). High-dose clopidogrel versus ticagrelor for treatment of acute coronary syndromes after percu-taneous coronary intervention in CYP2C19 intermediate or poor metabo-lizers: a prospective, randomized, open-label, single-center trial. Acta Cardiol, 71: 309-316.
24. Angiolillo DJ, Franchi F, Waksman R, et al (2016). Effects of Ticagrelor Versus Clopidogrel in Troponin-Negative Pa-tients With Low-Risk ACS Undergoing Ad Hoc PCI. J Am Coll Cardiol, 67: 603-613.
25. I, M O, A AS, Hh CH, W SF, Rahman M (2013). Evaluation of Aspirin and Clopidogrel resistance in patients with Acute Coronary Syndrome by using Adenosine Diposphate Test and Aspirin Test. Pak J Med Sci, 29: 97-102.