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Effects of Ticagrelor and Clopidogrel on Coronary Microcirculation in Patients with Acute Myocardial Infarction

Marco Antonio Scanavini-Filho1, Otavio Berwanger2, Wilson Matthias1

  • 1Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil.

Advances in Therapy
|February 26, 2022
PubMed

Insights

Ticagrelor did not improve coronary microcirculation in ST-elevation myocardial infarction patients treated with fibrinolytics, unlike clopidogrel. However, ticagrelor did show reduced platelet aggregation.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Research

Background:

  • Clopidogrel improves coronary microcirculation (CM) in ST-elevation myocardial infarction (STEMI) patients receiving fibrinolytics.
  • Ticagrelor, a potent adenosine diphosphate (ADP) receptor blocker, is superior to clopidogrel in acute coronary syndromes.

Purpose of the Study:

  • To compare the effects of ticagrelor and clopidogrel on coronary microcirculation in STEMI patients treated with fibrinolytics.

Main Methods:

  • Prospective study of 48 STEMI patients from the TREAT trial, randomized to ticagrelor or clopidogrel with fibrinolysis.
  • Primary endpoint: Coronary microcirculation assessed by global myocardial perfusion score index (global MPSI) via myocardial contrast echocardiography (MCE).
  • Secondary endpoint: Platelet aggregation to ADP measured by Multiplate® (AUC).

Main Results:

  • No significant difference in global MPSI between ticagrelor and clopidogrel groups (p=0.41).
  • Platelet aggregability was significantly lower in the ticagrelor group (18.1 ± 9.7 AUC) compared to the clopidogrel group (26.1 ± 12.5 AUC, p=0.01).

Conclusions:

  • Ticagrelor did not improve coronary microcirculation compared to clopidogrel in STEMI patients treated with fibrinolytics.
  • Despite lower platelet aggregation, ticagrelor did not enhance CM in this patient population.
Abstract

Keywords:
ClopidogrelCoronary microcirculationMyocardial contrast echocardiographyMyocardial perfusion score indexTicagrelor

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