Safety and efficacy of ticagrelor with emergency percutaneous coronary intervention in senile patients with ST-segment elevation myocardial infarction and dementia

Antiplatelet drug therapy is an important supportive measure for patients undergoing emergency percutaneous coronary intervention (PCI), to promote blood flow and reduce the risk of stent thrombosis. Ticagrelor is a new antiplatelet drug that offers some advantages over older drugs like clopidogrel in general ST-segment elevation myocardial infarction (STEMI) patients. However, its safety and efficacy in STEMI patients who also exhibit dementia and its underlying pathologies is unknown. Here, the application of ticagrelor was assessed in STEMI patients with dementia undergoing PCI. The study included 174 patients with dementia, ages 60 to 79 years, who were hospitalized due to STEMI from July 2014 to June 2015. All patients were treated by PCI. Before PCI, patients were randomly divided into two groups: one receiving ticagrelor and the other receiving clopidogrel to prevent cardiovascular thrombotic events. Patients were followed for 30 days to record cardiovascular events, bleeding, and other adverse reactions. Statistical analysis was performed using t-test, chi-square test and logistic regression analysis. The primary endpoint of vascular causes of death, stroke, and MI was less frequent in patients receiving ticagrelor than those receiving clopidogrel (P<0.05). The incidence of stent thrombosis was also lower in the ticagrelor group (P<0.05). However, some adverse events, i.e., upper gastrointestinal bleeding and dyspnea, were more common with ticagrelor administration (P<0.05). These findings indicate that ticagrelor offers some outcome advantages over clopidgrel in treating STEMI patients with dementia who undergo PCI, as seen for a broader population, as this intervention can reduce vascular-cause mortality, stroke, and recurrent myocardial infarction risks. Although bleeding was more frequent with ticagrelor treatment, it appeared to be less severe than with clopidogrel treatment.