Effect of Ticagrelor on Left Ventricular Remodeling in Patients With ST-Segment Elevation Myocardial Infarction
Yongwhi Park1, Jin Sin Koh2, Jae-Hwan Lee3
1Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea.
Insights
Ticagrelor demonstrated superior left ventricular (LV) remodeling compared to clopidogrel in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PCI). This suggests ticagrelor may offer better outcomes in STEMI recovery.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Animal studies suggest ticagrelor offers better myocardial protection against reperfusion injury than clopidogrel.
- Left ventricular (LV) remodeling is a critical factor in post-myocardial infarction outcomes.
Purpose of the Study:
- To compare the effects of ticagrelor and clopidogrel on LV remodeling after ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).
Main Methods:
- A randomized, open-label, assessor-blinded trial involving 336 STEMI patients undergoing primary PCI.
- Coprimary endpoints included LV remodeling index (LVRI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 6 months, assessed via 3D echocardiography.
Main Results:
- LVRI was numerically lower with ticagrelor (0.6 ± 18.6%) versus clopidogrel (4.5 ± 16.5%), though not statistically significant (p=0.095).
- Ticagrelor significantly reduced NT-proBNP levels at 6 months (173 ± 141 pg/ml vs. 289 ± 585 pg/ml; p=0.028).
- Ticagrelor use was associated with reduced risk for positive LV remodeling (OR: 0.56; p=0.030) and decreased LV end-systolic volume index.
Conclusions:
- Ticagrelor proved superior to clopidogrel in improving left ventricular remodeling following reperfusion in STEMI patients treated with primary PCI.
- The findings from the HEALING-AMI trial (NCT02224534) support ticagrelor's benefit in post-STEMI cardiac recovery.
Objectives:
The aim of this study was to evaluate the effect of ticagrelor versus clopidogrel on left ventricular (LV) remodeling after reperfusion of ST-segment elevation myocardial infarction (STEMI) in humans.
Background:
Animal studies have demonstrated that ticagrelor compared with clopidogrel better protects myocardium against reperfusion injury and improves remodeling after myocardial infarction.
Methods:
In this investigator-initiated, randomized, open-label, assessor-blinded trial performed at 10 centers in Korea, patients were enrolled if they had naive STEMI successfully treated with primary percutaneous coronary intervention (PCI) and at least 6-month planned duration of dual-antiplatelet treatment. The coprimary endpoints were LV remodeling index (LVRI) (a relative change of LV end-diastolic volume) measured on 3-dimensional echocardiography and N-terminal pro-B-type natriuretic peptide level at 6 months.
Results:
Among initially enrolled patients with STEMI (n = 336), 139 in each group completed the study. LVRI at 6 months was numerically lower with ticagrelor versus clopidogrel (0.6 ± 18.6% vs. 4.5 ± 16.5%; p = 0.095). Ticagrelor significantly reduced the 6-month level of N-terminal pro-B-type natriuretic peptide (173 ± 141 pg/ml vs. 289 ± 585 pg/ml; p = 0.028). These differences were prominent in patients with pre-PCI TIMI (Thrombolysis In Myocardial Infarction) flow grade 0. By multivariate analysis, ticagrelor versus clopidogrel reduced the risk for positive LV remodeling (LVRI >0%) (odds ratio: 0.56; 95% confidence interval: 0.33 to 0.95; p = 0.030). The LV end-diastolic volume index remained unchanged during ticagrelor treatment (from 54.7 ± 12.2 to 54.2 ± 12.2 ml/m2; p = 0.629), but this value increased over time during clopidogrel treatment (from 54.6 ± 11.3 to 56.4 ± 13.9 ml/m2; p = 0.056) (difference -2.3 ml/m2; 95% confidence interval: -4.8 to 0.2 ml/m2; p = 0.073). Ticagrelor reduced LV end-systolic volume index (from 27.0 ± 8.5 to 24.7 ± 8.4 ml/m2; p < 0.001), whereas no reduction was seen with clopidogrel (from 26.2 ± 8.9 to 25.6 ± 11.0 ml/m2; p = 0.366) (difference -1.8 ml/m2; 95% confidence interval: -3.5 to -0.1 ml/m2; p = 0.040).
Conclusions:
Ticagrelor was superior to clopidogrel for LV remodeling after reperfusion of STEMI with primary PCI. (High Platelet Inhibition With Ticagrelor to Improve Left Ventricular Remodeling in Patients With ST Segment Elevation Myocardial Infarction [HEALING-AMI]; NCT02224534).
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