Key result
Ticagrelor offered a similar degree of myocardial salvage compared to clopidogrel in patients with STEMI undergoing thrombolysis, with a mean myocardial salvage index of 54.29% versus 52.25% (p=0.83).
Why the study?
Ticagrelor's faster, stronger antiplatelet action and pleiotropic effects compared to clopidogrel could improve cardioprotection, but its effect on myocardial salvage index in thrombolyzed STEMI patients required comparative evaluation.
Does ticagrelor improve myocardial salvage index in STEMI patients undergoing thrombolysis compared to clopidogrel?
RCT (n=42)
Open-label
1:1
No
Does ticagrelor improve myocardial salvage index in STEMI patients undergoing thrombolysis compared to clopidogrel?
Absolute Event Rate: 54.29% vs 52.25%
p-value: p=0.83
In STEMI patients undergoing thrombolysis, ticagrelor offers a similar degree of myocardial salvage compared to clopidogrel.
Suggests ticagrelor may influence myocardial salvage in thrombolyzed STEM.
BACKGROUND: In the setting of ST-segment elevation myocardial infarction (STEMI), the faster and stronger antiplatelet action of ticagrelor compared to clopidogrel, as well as its pleiotropic effects, could result in a greater degree of cardioprotection and final infarct size (FIS) limitation. The aim of our study was to comparatively evaluate the effect of ticagrelor and clopidogrel on myocardial salvage index (MSI) in STEMI patients undergoing thrombolysis. METHODS: Forty-two STEMI patients treated with thrombolysis were randomized to receive clopidogrel (n = 21) or ticagrelor (n = 21), along with aspirin. Myocardial area at risk (AAR) was calculated according to the BARI and the APPROACH jeopardy scores. FIS was quantified by cardiac magnetic resonance imaging (CMR) performed 5-6 months post-randomization. MSI was calculated as (AAR-FIS)/AAR × 100%. Primary endpoint of our study was MSI. Secondary endpoints were FIS and CMR-derived left ventricular ejection fraction (LVEF) at 5 -6 months post-randomization. RESULTS: By using the BARI score for AAR calculation, mean MSI was 52.25 ± 30.5 for the clopidogrel group and 54.29 ± 31.08 for the ticagrelor group (p = 0.83), while mean MSI using the APPROACH score was calculated at 51.94 ± 30 and 53.09 ± 32.39 (p = 0.9), respectively. Median CMR-derived FIS-as a percentage of LV-was 10.7% ± 8.25 in the clopidogrel group and 12.09% ± 8.72 in the ticagrelor group (p = 0.6). Mean LVEF at 5-6 months post-randomization did not differ significantly between randomization groups. CONCLUSIONS: Our results suggest that the administration of ticagrelor in STEMI patients undergoing thrombolysis offer a similar degree of myocardial salvage, compared to clopidogrel.
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Petousis et al. (2022) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=42). Ticagrelor vs. Clopidogrel (300 mg loading dose, 75 mg od maintenance) was evaluated on Myocardial salvage index (MSI) using the BARI score (p=0.83). Ticagrelor offered a similar degree of myocardial salvage compared to clopidogrel in patients with STEMI undergoing thrombolysis, with a mean myocardial salvage index of 54.29% versus 52.25% (p=0.83).
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