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The Comparison of the Initial TIMI Flow Grade in Acute ST-Elevation Myocardial Infarction Patients Receiving
Amin Elahifar1, Ali Rafati1,2, Mohammad Javad Alemzadeh-Ansari1,2
1Rajaie Cardiovascular Medical and Research Center, Medical School, Iran University of Medical Sciences, Tehran, Iran.
Insights
Ticagrelor improves initial blood flow in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). This study found ticagrelor superior to clopidogrel for achieving better initial thrombolysis in myocardial infarction (TIMI) flow.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Primary percutaneous coronary intervention (PCI) is the gold standard treatment for acute ST-elevation myocardial infarction (STEMI).
- Ticagrelor has shown promise in reducing stent thrombosis risk compared to clopidogrel in STEMI patients.
- Optimizing initial coronary blood flow is crucial for improving outcomes in STEMI patients.
Purpose of the Study:
- To compare the initial Thrombolysis In Myocardial Infarction (TIMI) flow between ticagrelor and clopidogrel in STEMI patients undergoing primary PCI.
- To assess the impact of ticagrelor versus clopidogrel on early coronary reperfusion.
- To identify predictors of initial TIMI flow in STEMI patients.
Main Methods:
- A prospective cohort study involving 160 STEMI patients treated at Farshchian Heart Center.
- Patients received either ticagrelor (180 mg) or clopidogrel (600 mg) alongside aspirin before angiography.
- Initial and final TIMI flow grades were assessed, with logistic regression used to analyze predictors of initial flow.
Main Results:
- The ticagrelor group showed a significantly higher initial TIMI flow grade compared to the clopidogrel group (p=0.005).
- Specifically, 12.9% of ticagrelor patients achieved TIMI flow grade III versus 2.5% of clopidogrel patients.
- Ticagrelor was independently associated with a higher likelihood of achieving better initial TIMI flow (adjusted OR: 2.90).
Conclusions:
- Ticagrelor administration resulted in superior initial TIMI flow compared to clopidogrel in STEMI patients undergoing primary PCI.
- These findings suggest ticagrelor may facilitate more effective early reperfusion in STEMI.
- The improved initial flow with ticagrelor could have implications for reducing infarct size and improving clinical outcomes.
Objective:
Primary percutaneous coronary intervention (PCI) is the best treatment for acute ST-elevation myocardial infarction (STEMI). Evidence is in favor of ticagrelor over clopidegrel in STEMI patients regarding the reduction of stent thrombosis risk during and after PCI. We compared initial thrombolysis in myocardial infarction (TIMI) flow in STEMI patients on ticagrelor vs. clopidogrel.
Methods:
This prospective cohort recruited 160 patients with acute STEMI, referred to the emergency department of Farshchian Heart Center, during March 2018-2019. Before angiography, the patients received clopidogrel (600 mg) or ticagrelor (180 mg) on top of aspirin. Initial TIMI flow was compared between the two groups as the primary outcome. A logistic regression was performed to calculate the predictors of initial TIMI flow. Analyses were performed using R, version 4.2.1.
Results:
In ticagrelor and clopidogrel groups, the mean ± standard deviation age of the patients was 59.46 ± 13.11 and 61.34 ± 11.08 years (p value = 0.33), respectively. In the ticagrelor and clopidogrel groups, initial TIMI flow grades were as follows: 0 : 50% and 71.2%, I: 26.2% and 16.2%, II: 12.5% and 10%, and III: 12.9% and 2.5%, respectively (p value = 0.005). Final TIMI flow grades were as follows: I: 26.2% and 16.2%, II: 7.5% and 13.8%, and III: 66.3% and 70%, respectively (p value = 0.41). Ticagrelor was associated with significantly higher initial TIMI flow grade compared to the clopidogrel group (adjusted odds ratio: 2.90 (95% CI: 1.51-5.72)).
Conclusion:
In STEMI patients who were candidates for primary PCI, ticagrelor administration led to a better initial TIMI flow grade compared to clopidogrel.
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