Smaller infarct size with ticagrelor vs. clopidogrel in STEMI patients: Insights from cardiac magnetic resonance

Figures

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  Fig 1. Study flowchart. Of the 286 patients assessed, 40 were not enrolled in the trial due to inclusion/exclusion criteria or refusal to participate. Among those randomized to ticagrelor or clopidogrel, 21 did not complete the trial.

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  Fig 2. Box plots illustrating differences between the ticagrelor and clopidogrel groups on the first day of myocardial infarction. A – High-sensitivity troponin T (hsTNT); B – High-sensitivity C-reactive protein (hsCRP). Lower levels of hsTNT and hsCRP were observed among patients treated with ticagrelor compared to those treated with clopidogrel (Mann-Whitney test).

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  Fig 3. Network graph showing variable correlations on the 1st day (A, B) and the 30th day (C, D). In the ticagrelor arm, the most significant correlations with myocardial fibrosis on day 1 were high-sensitivity troponin T (hsTNT) and high-sensitivity C-reactive protein (hsCRP), whereas in the clopidogrel arm, hsTNT was the primary variable. By day 30, hsCRP, B2 cells, and creatinine were the main variables correlated with fibrosis in the clopidogrel arm, while creatinine and B2 cells were predominant in the ticagrelor arm. Blue lines indicate negative correlations; red lines indicate positive correlations.

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  Fig 4. Network graph depicting the most important correlations with left ventricular ejection fraction (LVEF). On the 1st day (E, F), in the clopidogrel arm, key correlations included high-sensitivity troponin T (hsTNT), high-sensitivity C-reactive protein (hsCRP), neutrophil-to-lymphocyte ratio (N/L), and systolic blood pressure (SBP), while in the ticagrelor arm, the same variables, along with lipid parameters, were correlated with LVEF. By the 30th day (G, H), in the clopidogrel arm, creatinine, B2 cells, and lipid parameters were the main correlations with LVEF, whereas in the ticagrelor arm, B2 cells, creatinine, and lipid parameters were also predominant. Blue lines indicate negative correlations; red lines indicate positive correlations.

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  Fig 5. Clusters of fibrosis and LVEF in the clopidogrel and ticagrelor arms. K-means analysis demonstrates moderate accuracy (57.3%). The graph shows that most patients in the ticagrelor arm had better LVEF and smaller infarct size.