Efficacy of clopidogrel and ticagrelor under NT-proBNP in hospitalized ST-elevation acute coronary syndrome patients on percutaneous coronary intervention: CCC-ACS Project Analysis

BACKGROUND

Risk stratification with specific biomarkers is proposed for tailored P2Y12 inhibitor therapy in patients with STEMI.

METHODS

This nationwide registry and quality improvement study is from November 1, 2014, to June 30, 2017. In total, 11,512 STEMI patients received aspirin and P2Y12 receptor inhibitor (clopidogrel or ticagrelor) and underwent PCIs in hospitals. Of the patients, 2992 were prescribed ticagrelor and 8520 clopidogrel. The primary effectiveness outcome was major adverse cardiovascular and cerebrovascular events (MACCE: cardiac death, myocardial infarction, stent thrombosis, in-hospital ischemic stroke). The primary safety outcome was in-hospital major bleeding.

RESULTS

MACCE incidence was lower in the ticagrelor group than in the clopidogrel group (0.8% versus 1.2%; P=0.046), but under different NT-proBNP levels, cumulative hazards of MACCE were without statistical significance. Bleeding rates were higher in the ticagrelor group than in the clopidogrel group (all bleeding: 9.9% versus 6.9%, P<0.001; major bleeding: 4.0% versus 2.7%, P<0.001). The higher cumulative hazard of bleeding could be identified in the Kaplan-Meier curves. In the multivariate analysis, ticagrelor increased bleeding events, compared with clopidogrel, at NT-proBNP >1800 ng/L patients (all bleeding: HR 1.46; 95%CI, 1.07-2.01; major bleeding: HR 1.68, 95%CI, 1.03-2.74), but a low effect was found in those with lower NT-proBNP level. Subgroup analyses show that ticagrelor increased major bleeding in patients with left ventricular ejection fraction (LVEF) <0.50 (HR 3.29; 95% CI 1.61-6.74) (interaction p=0.03).

CONCLUSION

We found that ticagrelor, compared with clopidogrel, increased bleeding complications in hospitalized patients with NT-proBNP>1800 ng/L, especially in patients with EF < 0.50.

[An experimental study of the influence of burn on the expressions of IFN-gamma and IL-4 in T lymphocytes and on the expression of IL-12 in macrophages in mice]

OBJECTIVE

To investigate the influence of burn on the expressions of IFN-gamma and IL-4 in T lymphocytes and on the expression of IL-12 in macrophages in mice.

METHODS

The mice inflicted by 12% TBSA burn on the back were employed as the model. The peritoneal macrophages (PMphis) were isolated and counted under light microscope (LM). The gene expression level of IL-12 P35 and P40 subunits was determined with RT-PCR. The ratio of spleen to body and splenic histology were also determined. Splenic T lymphocytes were isolated and the gene expression levels of IFN-gamma and IL-4 in the T lymphocytes were examined by RT-PCR.

RESULTS

(1) PMphis decreased significantly on 3 postburn day (PBD) and recovered quickly thereafter. (2) The gene expressions of IL-12 P35 and P40 subunits in PMphis were enhanced obviously. (3) Splenic index increased evidently and the karyokinesis phase increased in splenic lymphocytes. (4) The expressions of IFN-gamma and IL-4 in splenic T lymphocytes increased postburn.

CONCLUSION

The expressions of IFN-gamma and IL-4 in splenic T lymphocytes and the expressions of IL-12 in PMphis could be enhanced by burn injury.

Inhomogeneous distribution of brightness in the split-element filter

The inhomogeneous distribution of brightness in a split-element filter is discussed. This inhomogeneity is caused by the off-axis effect of the birefringent crystal and can seriously affect astronomical observations in the case of a large field of view. For example, the maximal brightness fluctuation is ~9.44% in a full-disk solar telescope whose maximal incident angle is 70 arcmin. We also discuss ways to avoid this disadvantage.

[Restrictive fragment length polymorphism analysis of gamma-crystallin in congenital cataract families]

Using gamma-crystallin gene probe P5G1, we investigated the RFLP in two large families of congenital cataracts and normal people, calculated the allelic gene frequency and defined the haplotypes by genetic linkage analysis. In accordance with foreign reports, TaqI/p5G1 detected 3 polymorphic sites, and the allelic gene frequency was close to that in foreign reports. However, foreign reports claimed that the haplotype P was linked to Coppock cataracts, but we did not find such linkage by haplotype analysis. The result suggests that not all the inherited cataracts are linked to gamma-crystallin gene, and the haplotype P should not be simply regarded as genetic marker in prenatal diagnosis.