Comparative Efficacy of Ticagrelor and Clopidogrel in ST-Elevation Myocardial Infarction Patients Undergoing Primary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Platelet Inhibition Therapy

Background:

• Ticagrelor offers faster platelet inhibition than clopidogrel.
• The impact of ticagrelor on myocardial injury during primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) is not fully understood.

Purpose of the Study:

• To evaluate the feasibility and preliminary effects of ticagrelor versus clopidogrel loading on myocardial injury.
• To assess myocardial injury in STEMI patients undergoing PCI using cardiac magnetic resonance (CMR) imaging.

Main Methods:

• Thirty STEMI patients were randomized to receive either ticagrelor (180 mg) or clopidogrel (300 mg) loading dose before PCI.
• Myocardial injury was assessed using CMR parameters (infarct size, MSI, MVO, infarct transmurality) 4-10 days post-PCI.
• Enzymatic infarct size and 5-year clinical outcomes were also analyzed.

Main Results:

• No significant differences were observed in infarct size, myocardial salvage index (MSI), microvascular obstruction (MVO), or other CMR parameters between the ticagrelor and clopidogrel groups.
• Left ventricular volume and function were comparable between groups.
• No major adverse cardiovascular events, stent thrombosis, or major bleeding occurred during the 5-year follow-up.

Conclusions:

• Ticagrelor and clopidogrel demonstrated similar effects on CMR-assessed myocardial injury and long-term clinical outcomes in STEMI patients undergoing PCI.
• These pilot findings are hypothesis-generating.
• The study supports the feasibility and informs sample-size calculations for future multicenter trials.