scholarly journals Musk Tongxin Dripping Pills for treating Ticagrelor in Patients After Percutaneous Coronary Intervention: Echocardiography Combined with Untargeted Metabolomics

2021 ◽  
Vol 12 ◽  
Author(s):  
Lyu Nan ◽  
Lai Peng ◽  
Zhao Jinxia ◽  
Guo Mengzhe ◽  
Liang Jun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Drug Combination ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Combination Group ◽  
Biochemical Indicators ◽  
Blood Biochemical ◽  
Percutaneous Coronary ◽  
Blood Biochemical Indicators

Objectives: As current clinical practice guidelines, ticagrelor is the suggested therapeutic scheme to prevent adverse cardiovascular events in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) treatment. However, this therapeutic strategy still fails, and around 30% patients display inadequate antiplatelet responses. Musk Tongxin Dripping Pill (MTDP) in Chinese hospital was usually considered as the combination with ticagrelor to improve the treatment effect. Unfortunately, the mechanism has not been elucidated.Methods: The untargeted metabolomic method was introduced based on liquid chromatography–high-resolution mass spectrometry (HPLC-HRMS) coupled with STI for the research of the drug combination mechanism between ticagrelor and MTDP. 28 patients with a confirmed diagnosis of AMI were selectively collected, who were then divided into two different dosage regimen groups, and the serum samples were collected for the untargeted metabolomics assay. Then the differential metabolites were associated with blood biochemical indicators.Results: The GLS values in both groups increased after treatment and those in the ticagrelor and MTDP combination group after treatment were higher than those in the ticagrelor group (p < 0.05), suggesting that the combination medication has better therapeutic effect on patients with myocardial infarction. From metabolomics analysis, the species of metabolites changed in two groups before and after treatment. Moreover, 93 differential metabolites changed in the drug combination group compared with the ticagrelor group after treatment (p < 0.05), which mainly related to changes in fatty acid metabolism pathways. Then the differential metabolites were found to be related with blood biochemical indicators, such as lipid, high-density lipoprotein (HDL), and low-density lipoprotein (LDL).Conclusion: This work will provide a possible mechanism of the drug combination interaction between ticagrelor and MTDP from two angles of echocardiography and metabonomics. Several potential metabolic pathways were also found to have a relationship with MTDP, which will provide a new perspective in clinical medication.

P5482The lipid paradox in patients with non-ST elevation and ST elevation myocardial infarction and percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C H Sia ◽  
A F W Ho ◽  
H Bulluck ◽  
H L Zheng ◽  
L L Foo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Acute Mi ◽  
St Elevation ◽  
Relationship Of ◽  
The Relationship

Abstract Background/Introduction Elevated levels of low-density lipoprotein (LDL-C) and triglycerides (TG) are well-described risk factors for the development of acute myocardial infarction (MI). Despite these well-established associations, previous studies have described the existence of a “lipid paradox” in acute MI patients – Patients paradoxically have worse outcomes despite having lower LDL-C and TG levels. Purpose We conducted this study to clarify the relationship of the lipid paradox and clinical outcomes amongst non-ST elevation (NSTEMI) and ST elevation MI (STEMI) patients in patients who have had percutaneous coronary intervention. Methods We included all acute MI patients reported to the Singapore Myocardial Infarction Registry from 2007 to 2013 who have had percutaneous coronary intervention. This information was linked to the national claims database to obtain the final discharge diagnosis for re-hospitalization outcomes. Exposure of interest was the lipid profile obtained within 72 hours of the acute MI (LDL-C, TG; Total cholesterol [TC]; high-density lipoprotein [HDL-C]). Primary outcomes were all-cause mortality during hospitalization, within 30-days and within 1-year. Secondary outcomes were re-hospitalization within 1-year for heart failure, stroke and MI. Results There were 8988 NSTEMI and 12453 STEMI cases available for analysis (n=21441). The NSTEMI patients were older (60.3 years vs 57.6 years, p<0.001) and more likely to be female (15.1% vs 22.6%, p<0.001). In the NSTEMI subgroup, a lower LDL-C was paradoxically associated with better outcomes for death during hospitalization, death within 30 days from MI onset and death within 1 year from MI onset (all p<0.001) across the various LDL-C levels. Adjustment for demographic variables, co-morbidities and MI characteristics eliminated this paradox. However, in the STEMI subgroup, the lipid paradox for LDL-C persisted for all primary outcome endpoints after adjustment. In the STEMI patients, a lower HDL-C also appeared to be protective. An elevated TG level did not appear to be protective in both NSTEMI and STEMI patients after adjustment. Conclusion(s) An elevated LDL-C appears to be a protective prognostic marker in STEMI but not NSTEMI patients who have undergone percutaneous coronary intervention. This difference may be due to differing underlying pathophysiological mechanisms between the 2 populations.

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