Comparison of Ticagrelor Monotherapy and Ticagrelor Plus Aspirin Among Patients With Acute Coronary Syndrome Combined With High-Risk of Gastrointestinal Bleeding After Percutaneous Coronary Intervention: A Retrospective Cohort Study.

ABSTRACT: To date, no studies have specifically examined the efficacy of P2Y12 inhibitor monotherapy in patients with acute coronary syndrome (ACS) exhibiting a high risk of gastrointestinal (GI) bleeding following percutaneous coronary intervention (PCI). This was a retrospective cohort study of ACS exhibiting a high GI bleeding risk after PCI admitted to the Affiliated Hospital of the Jiangnan University from August 2016 to December 2019. Of the 308 enrolled patients, 269 were found eligible and were assigned to the ticagrelor monotherapy (TIC) arm (n = 128) and to ticagrelor plus aspirin (TIC + ASP) arm (n = 141) treatment for a 1-year period. The primary study outcome was a composite end point, including bleeding academic research consortium (BARC) type 2, 3, or 5 bleeding and adverse cardiac or cerebrovascular events; 8 (6.3%) in the TIC group and 14 (9.9%) in the combination treatment group reached the primary ischemic end point within 1 year with no significant difference between these groups. BARC type 2, 3, and 5 bleeding events affected significantly more patients in the combination group relative to the TIC group (38 [27.0%] vs. 11 [8.6%], P < 0.001). As the follow-up interval was prolonged, the cumulative BARC type 2, 3, and 5 bleeding incidence in the TIC group remained significantly below than that in the combination treatment group ( P < 0.05). These results indicate that TIC is associated with a lower risk of clinically relevant bleeding events among ACS with a high risk of GI bleeding after PCI relative to combination TIC + ASP treatment, although ischemic outcomes in these 2 groups were similar.

Biomimetic material degradation for synergistic enhanced therapy by regulating endogenous energy metabolism imaging under hypothermia.

Inefficient tumour treatment approaches often cause fatal tumour metastases. Here, we report a biomimetic multifunctional nanoplatform explicitly engineered with a Co-based metal organic framework polydopamine heterostructure (MOF-PDA), anethole trithione (ADT), and a macrophage membrane. Co-MOF degradation in the tumour microenvironment releases Co2+, which results in the downregulation of HSP90 expression and the inhibition of cellular heat resistance, thereby improving the photothermal therapy effect of PDA. H2S secretion after the enzymatic hydrolysis of ADT leads to high-concentration gas therapy. Moreover, ADT changes the balance between nicotinamide adenine dinucleotide/flavin adenine dinucleotide (NADH/FAD) during tumour glycolysis. ATP synthesis is limited by NADH consumption, which triggers a certain degree of tumour growth inhibition and results in starvation therapy. Potentiated 2D/3D autofluorescence imaging of NADH/FAD is also achieved in liquid nitrogen and employed to efficiently monitor tumour therapy. The developed biomimetic nanoplatform provides an approach to treat orthotopic tumours and inhibit metastasis.