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The effect of ticagrelor on coronary microvascular function after PCI in patients with ACS compared to clopidogrel: A

Xiaohan Qiu1, Xiaohui Li1, Kang Fu1

  • 1Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China.

Plos One
|August 29, 2023
PubMed

Insights

Ticagrelor significantly improves coronary microcirculation in acute coronary syndrome patients compared to clopidogrel. This oral P2Y12 inhibitor enhances coronary blood flow and myocardial perfusion, offering better outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Medical Research

Background:

  • Coronary microcirculation function is crucial for predicting prognosis in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).
  • Ticagrelor, an oral P2Y12 inhibitor, is widely used in ACS and shows improved prognosis over clopidogrel, but its specific effects on coronary microcirculation remain unclear.
  • This meta-analysis aimed to clarify the comparative efficacy of ticagrelor versus clopidogrel on coronary microcirculation.

Approach:

  • A systematic literature search was conducted across PubMed, Cochrane CENTRAL, and ClinicalTrials.gov up to November 2022.
  • Data from 16 trials involving 3676 participants were pooled using fixed or random effects models based on heterogeneity.
  • Sensitivity analyses were performed to assess the impact of potential confounders.

Key Points:

  • Ticagrelor use was associated with a significant reduction in index of microcirculatory resistance (IMR) compared to clopidogrel (WMD: -6.23).
  • Ticagrelor also led to a reduction in coronary thermodilution-derived flow capacity (cTFC) (WMD: -1.88).
  • Patients on ticagrelor showed greater increases in coronary flow reserve (CFR) (WMD: 0.38), myocardial blush grade (MBG) (RR 1.29), and TIMI frame count (TFC) (RR 1.03).

Conclusions:

  • Ticagrelor demonstrates a significant positive impact on coronary microcirculation compared to clopidogrel.
  • The findings indicate ticagrelor effectively reduces microcirculatory resistance and enhances coronary blood flow.
  • Ticagrelor improves myocardial perfusion, suggesting a superior role in managing ACS patients post-PCI.
Abstract

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