Effects of Crushed Ticagrelor Versus Eptifibatide Bolus Plus Clopidogrel in Troponin‐Negative Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention: A Randomized Clinical Trial

Figures

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  Figure 1. Study design. ACT indicates activated dotting time; cTnI, cardiac troponin I; Hb/HCT, hemoglobin/hematocrit; PCI, percutaneous coronary intervention.

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  Figure 2. Patient disposition. cTnI indicates cardiac troponin I; FFR, fractional flow reserve; INR, international normalized ratio; PCI, percutaneous coronary intervention.

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  Figure 3. High on‐treatment platelet reactivity (HPR). HPR levels were significantly higher with crushed ticagrelor vs clopidogrel plus eptifibatide bolus at 0.5 and 2 hours after loading dose.

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  Figure 4. Platelet aggregation (PA) levels induced by ADP. Crushed ticagrelor (CTIC) significantly dropped PA induced by ADP 20 μmol/L at 2, 4, and 24 hours but not at 30 minutes. Eptifibatide bolus plus clopidogrel significantly dropped PA at 0.5, 2, and 4 hours. PA dropped faster from baseline with eptifibatide bolus plus clopidogrel vs CTIC (0.5 vs 2 hours, respectively) and was significantly higher with CTIC vs eptifibatide bolus plus clopidogrel at 0.5, 2, and 4 hours after loading dose. PA level was significantly higher with clopidogrel plus eptifibatide bolus vs CTIC at 24 hours. NS indicates not significant.

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  Figure 5. Platelet aggregation levels induced by thrombin receptor‐activating peptide (TRAP). Crushed ticagrelor (CTIC) did not significantly affect platelet aggregation (PA) induced by TRAP 20 μmol/L at 0.5, 2, 4, and 24 hours. In contrast, eptifibatide bolus plus clopidogrel significantly reduced PA induced by TRAP at 0.5, 2, and 4 hours. Furthermore, PA was significantly higher with CTIC vs clopidogrel plus eptifibatide bolus at 0.5, 2, and 4 hours after loading dose. NS indicates not significant.

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  Figure 6. Distribution of troponin I levels after percutaneous coronary intervention (PCI). The rate of periprocedural myocardial infarction and injury (PMI) was significantly higher with crushed ticagrelor vs eptifibatide bolus plus clopidogrel. Bars indicate the mean levels of PMI with 95% CIs for each group. The dotted line indicates the limit of 195 ng/L (5×99th percentile of upper reference limit [URL] of troponin levels=39 ng/L).