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Smaller infarct size with ticagrelor vs. clopidogrel in STEMI patients: Insights from cardiac magnetic resonance
Francisco A Fonseca1, Adriano Caixeta1, Gilberto Szarf1,2
1Cardiology Division, Universidade Federal de São Paulo, São Paulo, Brazil.
Insights
Ticagrelor significantly reduced infarct size in ST-segment elevation acute myocardial infarction (STEMI) patients compared to clopidogrel. This finding highlights ticagrelor
Area of Science:
- Cardiology
- Pharmacology
- Biomedical Imaging
Background:
- Ticagrelor exhibits cardiovascular protective effects beyond its antiplatelet activity.
- ST-segment elevation acute myocardial infarction (STEMI) is a critical condition requiring prompt intervention.
- Assessing infarct size is crucial for evaluating treatment efficacy in STEMI.
Purpose of the Study:
- To compare the efficacy of ticagrelor versus clopidogrel in reducing myocardial infarct size.
- To quantify infarct size using cardiac magnetic resonance (CMR) in STEMI patients.
- To evaluate the impact of ticagrelor and clopidogrel on left ventricular function and inflammatory markers.
Main Methods:
- A randomized study involving 225 adult STEMI patients treated with a pharmaco-invasive strategy.
- Patients received either ticagrelor or clopidogrel prior to invasive procedures.
- Cardiac magnetic resonance (CMR) was used to assess infarct size and left ventricular ejection fraction (LVEF) at 30 days.
Main Results:
- Ticagrelor treatment resulted in a significantly smaller percentage of left ventricular infarcted mass compared to clopidogrel (p=0.012).
- Angiographic findings, including Syntax and Gensini scores, were similar between the groups at baseline.
- Lower levels of high-sensitivity troponin T and C-reactive protein were observed on day one in the ticagrelor group.
Conclusions:
- Ticagrelor therapy is associated with smaller infarct size in STEMI patients undergoing a pharmaco-invasive strategy.
- The findings suggest potential benefits of ticagrelor in limiting myocardial damage post-STEMI.
- Further research may explore the long-term clinical implications of these observed differences.
Background:
Ticagrelor has many protective cardiovascular properties beyond potent antiplatelet action. This study aimed to compare the effects of ticagrelor versus clopidogrel on infarcted mass, quantified by cardiac magnetic resonance (CMR), in patients with ST-segment elevation acute myocardial infarction (STEMI).
Methods:
Adult patients of both sexes with STEMI under a pharmaco-invasive strategy were included (n = 225). Patients were treated by thrombolysis within six hours of symptom onset and underwent angiography with percutaneous coronary interventions, when needed, within the first 24 hours. Prior to the invasive procedures, patients were randomly assigned to receive either ticagrelor or clopidogrel using a centralized computerized system. Patients were followed on a weekly basis to optimize their medical therapy.
Results:
After 30 days, CMR was performed and a smaller percentage of left ventricular infarcted mass was found with ticagrelor (p = 0.012), despite similar angiographic findings at baseline (Syntax score, Gensini score, culprit artery, TIMI flow, and myocardial blush). At 30 days, left ventricular ejection fraction (LVEF) was comparable between groups. Still, the K-means algorithm displayed more homogeneous responses for smaller infarcted mass and better LVEF among those patients treated with ticagrelor. Standard lipid panel and most inflammatory parameters were similar at baseline and after 30 days. However, lower high-sensitivity troponin T and high-sensitivity C-reactive protein levels were found in samples collected from patients treated with ticagrelor on the first day of STEMI.
Conclusion:
In patients with STEMI under a pharmaco-invasive strategy, therapy with ticagrelor was associated with a smaller infarct size than clopidogrel.
Trial Registration:
Clinicaltrials.gov (NCT02428374).
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