Abstract
IMPACT OF STATINS COMBINATION WITH DUAL ANTIPLATELET THERAPY ON ANTI-INFLAMMATORY FACTORS AND MYOCARDIAL PROTECTIVE EFFECTS IN ACUTE STEMI PATIENTS AFTER EMERGENCY PCI

Zakarya Ahmed*, MD, Hesong Zeng*, MD, PhD, Chang Xu, MD, PhD and NaNa Tang, BSN

ABSTRACT

Background: Early reperfusion of the occluded coronary artery which cause an acute myocardial infarction extremely concerned important for the reduction of infarction size and the retrieval of ventricular function. A participation in microvascular injury, the balance between protective and harmful inflammatory factors may have roles in reperfusion injury and may affect final ventricular remodeling. AIMS: This Study aims to compare the anti-inflammatory effects of atorvastatin or rosuvastatin when co-administered with ticagrelor versus clopidogrel as a long-term treatment for AMI patients underwent urgent PCI. Moreover, to compare the effectiveness of NT-proBNP and left ventricular ejection fraction (LVEF) in predicting prognosis of STEMI. Methods: We retrospectively analyzed 490 patients who underwent urgent PCI for AMI from 2015 to 2017 in our hospital. We compared the effects of four therapeutic groups (atorvastatin/ticagrelor AT, atorvastatin/clopidogrel AC, rosuvastatin/ ticagrelor RT, and rosuvastatin/clopidogrel RC) on the related indicators of serum inflammatory factors, NT-proBNP, and left ventricular remodeling. We also compared the combined endpoint which was cardiovascular death, MI, or stroke at 12 months after PCI. Results: No statistically significant difference was found in the levels of HCY, MHR, NLR, NT-proBNP, LVD, LAD and LVEF at the admission time between the four groups (P>0.05); However, their levels most decrease was observed at group AT after 12 months (P<0.05). The incidence rates of ischemic endpoint events within 12months were lower in the AT group than in the other groups (3 (2.7%), 2(1.8%), 4(3.0%), and 3(2.2%) at groups AT, AC, RT, and RC) P<0.023. The occurrence rate of the major bleeding was similar in the groups AT, and RT (3 (2.6%), 2 (1.8%), 3 (2.2%), and 1 (0.7%) at AT, AC, RT, and RC groups, P<0.05, respectively. However, the differences noticed in the cardiac death, re-attack of myocardial infarction, urgent coronary revascularization, cerebral stroke, safety endpoint events, secondary bleeding events slight bleeding events were not statistically significant (P>0.05). Conclusions: Among patients receiving DAPT, rosuvastatin but not atorvastatin is associated with an increased rate of HRPR for clopidogrel, without any influence on the antiplatelet effect of ASA or ticagrelor. Therefore, cautiousness should be exerted for clopidogrel and rosuvastatin therapeutic association.

Keywords: atorvastatin; rosuvastatin; ticagrelor; clopidogrel; acute myocardial infarction; homocysteine.


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