Key result
Ticagrelor loading before primary PCI did not significantly reduce myocardial infarct size assessed by SPECT compared to clopidogrel loading in patients with STEMI (32.8% vs. 28.1%; p=0.169).
Why the study?
Does ticagrelor loading reduce myocardial infarct size in patients with STEMI undergoing primary PCI compared to clopidogrel loading?
RCT (n=188)
Open-label
Randomized
No
Does ticagrelor loading reduce myocardial infarct size in patients with STEMI undergoing primary PCI compared to clopidogrel loading?
Absolute Event Rate: 32.8% vs 28.1%
p-value: p=0.169
In patients with STEMI undergoing primary PCI, a loading dose of ticagrelor did not significantly reduce myocardial infarct size compared to a loading dose of clopidogrel.
Ticagrelor loading offers no infarct size benefit over clopidogrel in STEMI; hypothesis-generating and should not change practice.
BACKGROUND AND OBJECTIVES: Ticagrelor is considered a potent antiplatelet agent compared to clopidogrel. However, there are no studies regarding the effect of ticagrelor loading on infarct size in patients with ST-segment elevation myocardial infarction (STEMI) in a primary percutaneous coronary intervention (PCI) setting. SUBJECTS AND METHODS: In this single-center, randomized, open-label study, 188 patients who underwent primary PCI for STEMI were enrolled (92 patients in the clopidogrel group and 96 in the ticagrelor group) and compared the infarct size by technetium-99m (Tc-99m) tetrofosmin single-photon emission computed tomography (SPECT) and serial cardiac biomarker levels between the groups. SPECT was performed at a median of 2 days after PCI. RESULTS: Baseline clinical and procedural characteristics were similar between the groups. Infarct size on SPECT, was similar between the 2 groups (28.1%±34.5% vs. 32.8%±29.2%; p=0.169). At all time-points after PCI (8, 24, and 48 hours), the peak levels of creatine kinase-myocardial band (CK-MB) and troponin T were lower in the clopidogrel group. The clopidogrel group showed lower cumulative troponin T levels than the ticagrelor group (12.59±10.66 vs. 17.67±19.51 ng/mL; p=0.029). CONCLUSION: Ticagrelor loading before primary PCI was not associated with reduced myocardial infarct size during the first 48 hours, compared to clopidogrel loading.
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Yun et al. (2017) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=188). Ticagrelor vs. Clopidogrel (300 mg loading dose) was evaluated on Myocardial infarct size, as assessed by SPECT (p=0.169). Ticagrelor loading before primary PCI did not significantly reduce myocardial infarct size assessed by SPECT compared to clopidogrel loading in patients with STEMI (32.8% vs. 28.1%; p=0.169).
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