1 INTRODUCTION 1 Rationale Lower extremity artery disease (PAD) is increasingly common in the world as well as in Vietnam Although this is the cause of amputation and increases the risk of cardiovascu[.]
1 INTRODUCTION Rationale Lower extremity artery disease (PAD) is increasingly common in the world as well as in Vietnam Although this is the cause of amputation and increases the risk of cardiovascular events, the PAD often progresses silently with atypical symptoms and is easily misdiagnosed ABI measurement method with compact equipment, simple technique and high value is suitable for early diagnosis of PAD, thereby helping to treat the disease in time, contributing to improving prognosis and quality of life for the patient For the treatment of PAD, in addition to drugs and techniques aimed at increasing perfusion to the lower extremities, the prevention of cardiovascular events and deaths with antiplatelet agents is an important goal Ticagrelor is a new antiplatelet agent The advantage of ticagrelor is that it is not metabolized by the liver like clopidogrel The PLATO trial in coronary artery disease showed that ticagrelor was more effective than clopidogrel in preventing cardiovascular events The analysis of a group of patients with PAD in this trial also showed similar results, but the difference was not statistically significant In Vietnam, so far, there have been no study on patients with PAD to confirm whether ticagrelor is really superior to clopidogrel in preventing cardiovascular events in this patient population or not? For the purpose of evaluating the diagnostic value of the ABI and the cardiovascular event prevention effect of ticagrelor compared with clopidogrel in patients with PAD, our study “Value of ankle – branchial index (ABI) and treatment result of ticagrelor in patient with lower extremity artery disease” was conducted and aimed to: (1) Evaluate the value of ABI and some related factors in the diagnosis of lower extremity artery disease in compared with the MSCT scan of the lower extremity artery (2) Compare the results of cardiovascular event preventive treatment of ticagrelor with clopidogrel in patients with lower extremity artery disease 2 The significance of thesis Atherosclerosis, including lower extremity artery disease, is rapidly increasing This group of diseases increases the cardiovascular mortality rate, the hospitalization rate, the disability rate and increases the burden on society Therefore, early diagnosis, improving the quality of treatment with new methods and new drugs are essential Novel findings in the thesis The ABI index has a high sensitivity and specificity in the diagnosis of lower extremity artery disease when compared with the MSCT method, and closely correlates with the degree of arterial damage as well as the clinical presentation of the disease The study results showed that the prevention effect of cardiovascular events and mortality of ticagrelor in patients with lower extremity artery disease was equal to that of clopidogrel The rates of bleeding complications of these two drugs in patients with lower extremity artery disease were not statistically significant Thesis structure This thesis has 137 pages, divided into the following chapters: Rationale (2 pages); Background (42 pages); Patients and Methods (25 pages), Results (37 pages); Discussion (28 pages); Results (2 pages); Proposals (1 page) This thesis consists of 34 tables, 11 figures and charts, 157 references with and 148 of which are in Vietnamese and English respectively CHAPTER BACKGROUND 1.1 The ABI measurement method in diagnosis of lower extremity artery disease 1.1.1 Concept of the ankle – branchial index (ABI) The ankle – branchial systolic pressure index (ABI) is the ratio of the systolic blood pressure measured in the ankle (anterior tibial artery or posterior tibial artery) to the arm systolic blood pressure 3 1.1.2 The PAD screening recommendation for high-risk patients with ABI Age ≥ 65 years old Age 50- 64 years old and at risk of atherosclerosis (a history of smoking, diabetes, dyslipidemia, hypertension) or a family history of peripheral artery disease Age 0,5; it is less likely to lead to severe anemia in the next years If the ABI is