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Objective: To observe the efficacy of ticagrelor for treating elderly acute coronary syndrome (ACS) patients with elective PCI and having low response to clopidogrel; to explore the bleeding risks induced by ticagrelor replacement. Methods: A total of 945 ACS patients ≥ 65 years treated in our hospital from 2014-01 to 2017-01 were enrolled. All patients received aspirin and clopidogrel dual antiplatelet therapy (DAPT), thrombelastography (TEG) was used to detect platelet inhibition rate when DAPT ≥ 5 days. Based on platelet inhibition rate, the patients were divided into 2 groups:Ticagrelor replacement group, n=293 patients with low response to clopidogrel and switched to ticagrelor treatment, when adjusted DAPT ≥ 5 days, platelet inhibition rate was rechecked to compare the changes; Clopidogrel group, the patients were continuously treated by the same medication, n=652. The patients were followed-up for 3 months, bleeding events were evaluated by TIMI criteria and compared between 2 groups. Risk factors of ticagrelor induced bleeding were assessed by multivariate Logistic regression analysis. Results: Platelet inhibition rates in Ticagrelor replacement group were (51.70±42.90) %, (48.99±41.85) % and (55.08±25.70) % at (5-7) d, (8-14) d and (15-90) d ticagrelor treatment, which were higher than previous clopidogrel treatment (14.50±24.15) %, all P<0.05. The incidences of severe bleeding events were similar between 2 groups, P=0.96. Multivariate Logistic regression analysis presented that female (OR=4.329, P=0.000), low body weight (OR=0.817, P=0.039) and elevated fasting blood glucose (OR=1.251, P=0.028) were the independent risk factors for bleeding complication in ticagrelor treated elderly ACS patients. Conclusion: Compared with clopidogrel, ticagrelor may faster and more effectively inhibit platelet aggregation without increasing severe bleeding; female, low body weight and elevated fasting blood glucose were the independent risk factors for bleeding complication in ticagrelor treated elderly ACS patients with elective PCI.
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Objective To investingate the possible predictory of radial artery occlusion(RAO) after transradial approach and its preventive measures.Methods We prospectively assessed the occurrence of RAO in 669 consecutive patients undergoing transradial approach and 63 patients were excluded from the final study (24of them did not meet the inclusion criterium,31 patients converted to other artery approaches,6 patients lost clinical follow-up and 2 patients died).Artery occlusion was evaluated with Doppler ultrasound in 2 days and 1 year after the intervention.The risk factors of RAO including sex,body mass index (BMI),smoking,hypertension,diabetes,dyslipidemia,puncture site,vessel spasm,and artery diameter/ sheath ratio were evaluated using a multivariate model analysis.Results Among the 606 patients,RAO occurred in 56 patients.There were no differences in sex,age,BMI,coronary lesions,rates of vessel spasm,vessel length,medication given and operation time between the 2 group of patients with vs without ROA (all P＞0.05).Univariate logistic analysis showed puncture site at 0 cm away from radial styloid and artery diameter/sheath ratio ≤ 1 were possible risk factory and puncture site ＞ 4 cm from radial styloid was possible protective factor.Further multivariate analysis showed the odds ratio (OR) for occlusion risk at 0 cm and 1 cm were 9.65 (P=0.033) and 8.90 (P=0.040),respectively.The RAO occurred in the ratio of the arterial diameter to the sheath diameter ≤ 1 (OR=2.45,P=0.004).Conclusions Distal puncture sites (0-1 cm away from the radius styloid process) can lead to a higher rate of RAO.