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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Beneficial effect of ticagrelor on microvascular perfusion in patients with ST-segment elevation myocardial
Xuechao Wang1, Xinning Li, Haibo Wu
1Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China.
Insights
Ticagrelor improved microvascular perfusion and heart function in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). This P2Y12 inhibitor also reduced major adverse cardiac events compared to clopidogrel.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Ticagrelor effectively reduces adverse events in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI).
- The impact of ticagrelor on microvascular perfusion in STEMI patients has not been fully elucidated.
Purpose of the Study:
- To evaluate the effects of ticagrelor versus clopidogrel on microvascular perfusion in STEMI patients undergoing pPCI.
- To compare ST-segment resolution, myocardial blush grade, and corrected thrombolysis in myocardial infarction frame count between the two treatment groups.
Main Methods:
- A randomized trial involving 298 STEMI patients undergoing pPCI.
- Patients received either ticagrelor or clopidogrel loading dose and maintenance therapy.
- Primary endpoint: ST-segment resolution at 90 minutes; Secondary endpoints: myocardial blush grade, corrected thrombolysis in myocardial infarction frame count, left ventricular ejection fraction, and major adverse cardiac events (MACE).
Main Results:
- Ticagrelor demonstrated a significantly higher rate of ST-segment resolution (58.67% vs. 39.86%).
- Improved myocardial blush grade (2.63±0.64 vs. 2.41±0.71) and lower corrected thrombolysis in myocardial infarction frame count (19.68±7.38 vs. 22.35±8.30) were observed with ticagrelor.
- Ticagrelor group showed higher left ventricular ejection fraction at 6 months (55.01±8.44% vs. 52.34±9.05%) and improved MACE-free survival.
Conclusions:
- Ticagrelor significantly improves myocardial perfusion and left ventricular function in STEMI patients undergoing pPCI compared to clopidogrel.
- Ticagrelor reduces major adverse cardiac events without a significant increase in major bleeding.
- These findings support ticagrelor as a superior therapeutic option for STEMI patients undergoing pPCI.
Background:
Ticagrelor significantly reduced the incidence of death, myocardial infarction, and stent thrombosis in patients with ST-segment elevation myocardial infarction (STEMI) intended for reperfusion with a primary percutaneous coronary intervention (pPCI). However, the effects of this drug on microvascular perfusion in patients presenting with STEMI have not been evaluated completely.
Patients And Methods:
A total of 298 patients presenting with STEMI were randomized to either ticagrelor 180 mg loading, followed by 90 mg twice daily, or clopidogrel 600 mg loading, followed by 75 mg daily. The primary endpoint was ST-segment resolution at 90 min after pPCI. The secondary endpoints included myocardial blush grade and corrected thrombolysis in myocardial infarction frame count after the procedure. Left ventricular ejection fraction and major adverse cardiac events (MACE) at the 1- and 6-month follow-up time points were also recorded.
Results:
There were no significant differences between the two groups with respect to baseline characteristics. Ticagrelor administration resulted in a higher rate of completed ST-segment resolution (58.67 vs. 39.86%, P=0.001), higher myocardial blush grade (2.63±0.64 vs. 2.41±0.71, P=0.005), and lower corrected thrombolysis in myocardial infarction frame count (19.68±7.38 vs. 22.35±8.30, P=0.004). At 6 months, left ventricular ejection fraction was higher (55.01±8.44 vs. 52.34±9.05%, P=0.009) in the ticagrelor group. Kaplan-Meier analysis showed that MACE-free survival had also improved in the ticagrelor group during the 1- and 6-month follow-up time points.
Conclusion:
Compared with clopidogrel, ticagrelor improves myocardial perfusion and left ventricular ejection fraction, and reduces the incidence of MACE for STEMI patients undergoing pPCI, with no significant increase in major bleeding.
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