Effects of oral ticagrelor or clopidogrel before emergent PCI on the inflammatory mediators and endotheliocyte functions in STEMI patients

Objective: To investigate the effects of oral ticagrelor or clopidogrel before emergent percutaneous coronary intervention (PCI) on the inflammatory mediators and endotheliocyte functions in patients with ST elevation myocardial infarction (STEMI). Methods: Totally 349 STEMI patients from February 2013 to February 2016 were enrolled. All the patients were treated with aspirin. In addition to the treatment with aspirin, 155 patients were given ticagrelor (test group) and the other 194 patients given clopidogrel (control group). The changes in inflammatory mediators (tumor necrosis factor-related activator protein (CD40L), P selectin, and C reactive protein (CRP)) and endotheliocyte function indexes (nitric oxide (NO), von Willebrand disease factor (vWF), and plasma soluble intercellular adhesion molecule (sICAM-1)) were observed and compared before PCI, during PCI, and 4 weeks after PCI between the two groups. Results: Both ticagrelor and clopidogrel could effectively decrease the intra-operative levels of CD40L and P selectin (compared with those before PCI, P<0.05) and maintain the CRP levels stable during and after PCI (compared with that before PCI, P>0.05); 4 weeks after PCI, CD40L and P selectin were increased compared with those during PCI (P<0.05), but the CD40L level was still decreased compared with that before PCI (P<0.05), and P selectin was recovered to a level similar to that before PCI (P<0.05). Four weeks after PCI, both groups had significantly improved NO but decreased vWF, and sICAM-1 compared with those before and during PCI (all P<0.05). Four weeks after PCI, the test group had a significantly higher NO level but significantly lower vWF and sICAM-1 levels than the control group (all P<0.05), and the differences in the other indexes at the other time points between the two groups were statistically insignificant. The two groups had insignificantly different incidences of adverse events (P>0.05). Conclusion: Both ticagrelor and clopidogrel can effectively improve the inflammatory mediators and endotheliocyte functions in STEMI patients; the two groups have similar effects on inflammatory mediators, but the ticagrelor group has significantly better improving effects on endothelium-dependent diastolic function than the clopidogrel group.