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Ticagrelor vs. clopidogrel for coronary microvascular dysfunction in patients with STEMI: a meta-analysis of

Yike Li1, Zixiang Ye2, Ziyu Guo3

  • 1Department of Cardiology, China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Frontiers in Cardiovascular Medicine
|June 5, 2023
PubMed

Insights

Ticagrelor significantly improves coronary microcirculation blood flow and myocardial perfusion in ST-segment elevation myocardial infarction (STEMI) patients compared to clopidogrel. This suggests ticagrelor may be more beneficial for microvascular function post-primary percutaneous coronary intervention.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Coronary microvascular dysfunction affects approximately half of ST-segment elevation myocardial infarction (STEMI) patients undergoing revascularization.
  • Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard post-STEMI to reduce cardiovascular events.

Purpose of the Study:

  • To compare the effects of ticagrelor versus clopidogrel on coronary microcirculation dysfunction in STEMI patients undergoing primary percutaneous coronary intervention (PCI).
  • To conduct a pooled analysis of randomized controlled trials (RCTs) evaluating P2Y12 inhibitors in STEMI.

Main Methods:

  • A systematic literature search of PubMed, Embase, Cochrane Library, and Web of Science was conducted up to September 2022.
  • Included RCTs assessed coronary microcirculation using metrics such as corrected TIMI frame count (cTFC), myocardial blush grade (MBG), and TIMI myocardial perfusion grade (TMPG).

Main Results:

  • Seven RCTs involving 957 patients (476 ticagrelor, 481 clopidogrel) were analyzed.
  • Ticagrelor demonstrated superior acceleration of microcirculation blood flow (cTFC: -2.40, p<0.001) and improved myocardial perfusion (MBG ≥ 2: OR 2.57, p<0.001) compared to clopidogrel.

Conclusions:

  • Ticagrelor offers greater benefits for coronary microcirculation than clopidogrel in STEMI patients undergoing primary PCI.
  • Further studies on clinical outcomes are needed to guide P2Y12 inhibitor selection in STEMI patients.
Abstract

Keywords:
ST-elevation myocardial infarctionclopidogrelcoronary microcirculation dysfunctionmeta-analysisticagrelor

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