Key result
Ticagrelor did not improve coronary microcirculation compared to clopidogrel in patients with STEMI treated with fibrinolytics, showing no significant difference in global myocardial perfusion score index (p=0.417).
Why the study?
Clopidogrel improves coronary microcirculation after fibrinolysis for STEMI, and ticagrelor is a more potent ADP receptor blocker, but their comparative effects on coronary microcirculation in this setting remained unknown.
Does ticagrelor improve coronary microcirculation compared to clopidogrel in patients with STEMI treated with fibrinolytics?
RCT (n=48)
Open-label
Web-based, central, automated randomization system
Yes
Does ticagrelor improve coronary microcirculation compared to clopidogrel in patients with STEMI treated with fibrinolytics?
Absolute Event Rate: 1.41% vs 1.29%
p-value: p=0.417
In patients with STEMI treated with fibrinolytics, ticagrelor did not improve coronary microcirculation compared to clopidogrel, despite achieving lower platelet aggregability.
No microcirculatory benefit seen with ticagrelor versus clopidogrel in fibrinolytic-treated STEMI; hypothesis-generating and should not change practice.
INTRODUCTION: Clopidogrel has been demonstrated to be effective in improving coronary microcirculation (CM) among patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolytics. Ticagrelor is a more potent adenosine diphosphate (ADP) receptor blocker proven to be superior to clopidogrel among patients with acute coronary syndromes. The present study aimed to compare the effects of ticagrelor and clopidogrel on CM in patients with STEMI treated with fibrinolytics. METHODS: The present study prospectively included 48 patients participating in the TREAT trial, which randomly assigned patients with STEMI undergoing fibrinolysis to ticagrelor versus clopidogrel. The primary endpoint of this study was the evaluation of the CM using the global myocardial perfusion score index (global MPSI) obtained by myocardial contrast echocardiography (MCE). Platelet aggregation to ADP was evaluated by Multiplate® and expressed as area under the curve (AUC). RESULTS: The global MPSI demonstrated no differences between the groups [mean 1.4 (1.2-1.5) in the ticagrelor group and 1.2 (1.2-1.5) in the clopidogrel group (p = 0.41)]. Platelet aggregability was lower in the ticagrelor group (18.1 ± 9.7 AUC), compared to the clopidogrel group (26.1 ± 12.5 AUC, p = 0.01). CONCLUSION: We found no improvement in coronary microcirculation with ticagrelor compared to clopidogrel among patients with STEMI treated with fibrinolytics, despite the fact that platelet aggregation to ADP was lower with ticagrelor. CLINICAL TRIALS REGISTRATION: NCT03104062.
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Scanavini-Filho et al. (2022) conducted an RCT in ST-elevation myocardial infarction (STEMI) (n=48). Ticagrelor vs. Clopidogrel was evaluated on Global myocardial perfusion score index (global MPSI) obtained by myocardial contrast echocardiography (p=0.417). Ticagrelor did not improve coronary microcirculation compared to clopidogrel in patients with STEMI treated with fibrinolytics, showing no significant difference in global myocardial perfusion score index (p=0.417).
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