Clopidogrel

Patients received treatment based on their angiographic features of coronary lesions. All patients were administered enteric aspirin oral 300 mg (Approval No. J20171021; Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ, USA) and clopidogrel 300 mg (approval No. J20180029; Sanofi (Hangzhou) Pharmaceuticals Co. Ltd., Hangzhou, China) for secondary prevention of cardiovascular diseases. Patients in the stent group underwent coronary angiography and conventional stent implantation surgery. Patients in the CABG group were given medicine and CABG surgery.
Baseline data were collected from the three groups including gender, age, history of diseases (hypertension, diabetes, hyperlipidemia), unstable angina or acute non-ST-elevation myocardial infarction. GRACE and SYNTAX scores were calculated. Data on patient prognosis were obtained through telephone follow-up or clinical visits. Hospitalization and coronary angiography were advised for patients with symptoms such as typical chest pain or ischemia. The end points of follow-up were the occurrence of major adverse cardiovascular events (MACEs) after the treatments including cardiac death, non-fatal myocardial infarction, and target lesion revascularization. MACE was estimated. Patients were followed-up for 46 mo.

Procedures were performed under general anesthesia on a biplane angiographic system (Axiom Artis, Siemens Biplane and Allura Clarity, Philips Healthcare). Since 2013, all patients treated with WEB (with or without stent) received premedication with double antiplatelet treatment (DAPT). Two protocols were used successively: aspirin and clopidogrel (Sanofi-Aventis, Gentilly, France) for 5 days until April 2015, followed by aspirin and ticagrelor (AstraZeneca, Courbevoie, France) for 2 days. The change of DAPT protocol was prompted by the high rate of clopidogrel resistance. In the event of stent placement, this treatment continued for 3 months; thereafter, clopidogrel or ticagrelor were stopped and aspirin continued for at least 12 months post-procedure date. Antiplatelet activity testing was not performed.
Post-procedure MRI including diffusion-weighted imaging (DWI) was performed 24 hours post-procedure. Digital subtraction angiography (DSA) was performed at 6 and 12 months.

Venous blood (3 ml) was collected using vacuum anticoagulation blood collection tube from the patients on admission. Patients in STEMI, NSTEMI and UAP groups were treated with aspirin (Bayer AG, Leverkusen, Germany) at a dose of 100 mg Qd and clopidogrel (Sanofi S.A., Paris, France) at a dose of 75 mg Qd. Fasting blood was extracted from each patient on the 3rd, 7th and 10th day after treatment. Serum levels of STLT-1 were determined using ELISA kit (Oumeng, Biotechnology Co. Ltd., Beijing, China). An ADVIA1800 automatic biochemical analyzer was used to determine serum bilirubin levels (Siemens, Berlin, Germany). The patients were followed up by telephone for a year at regular intervals after discharge. The prognosis of the patients was analyzed.