Key result
Ticagrelor improves myocardial microcirculation and reduces necrosis markers versus clopidogrel in diabetic STEMI patients.
Why the study?
To investigate the protective effect of ticagrelor on the myocardium of patients with ST-elevated acute coronary syndrome accompanied by diabetes mellitus.
Does ticagrelor improve myocardial microcirculation perfusion and reduce myocardial injury compared to clopidogrel in patients with ST-elevated acute coronary syndrome and diabetes mellitus undergoing emergency PCI?
RCT (n=210)
Randomly divided
No
Does ticagrelor improve myocardial microcirculation perfusion and reduce myocardial injury compared to clopidogrel in patients with ST-elevated acute coronary syndrome and diabetes mellitus undergoing emergency PCI?
p-value: p=<0.01
In patients with ST-elevated acute coronary syndrome and diabetes mellitus undergoing emergency PCI, ticagrelor improves myocardial microcirculation perfusion and reduces myocardial injury markers compared to clopidogrel, albeit with an increase in mild bleeding.
May support ticagrelor for myocardial protection in diabetic STEMI; leaves open need for larger confirmatory trials.
OBJECTIVE: To investigate the protective effect of ticagrelor on the myocardium of patients with ST-elevated acute coronary syndrome accompanied by diabetes mellitus. PATIENTS AND METHODS: 210 patients with diabetes mellitus receiving emergency percutaneous coronary intervention (PCI) due to ST-elevated acute coronary syndrome from December 2014 to June 2018 in the Hospital were selected and randomly divided into ticagrelor group and clopidogrel group. The myocardial microcirculation perfusion was evaluated via ST-segment elevation resolution (STR) in electrocardiogram (ECG) and myocardial blush grade (MBG). Myocardial necrosis markers, including creatine kinase (CK), CK-MB, and cardiac troponin I (cTnI), were evaluated. Moreover, the cardiac function was assessed using brain natriuretic peptide (BNP) level and left ventricular ejection fraction (LVEF). Finally, patients were followed up for one month on average, and the adverse cardiovascular and bleeding events were recorded. RESULTS: The results showed that CK, CK-MB, cTnI, and BNP levels in ticagrelor group were lower than those in clopidogrel group, and the differences were statistically significant (p<0.05). Thrombolysis in myocardial infarction (TIMI) flow grading after the operation had no statistically significant difference between the two groups, and the usage rate of tirofiban in ticagrelor group was lower than that in clopidogrel group (p<0.05). Besides, the myocardial microcirculation perfusion level after the operation in ticagrelor group was significantly higher than that in clopidogrel group. The proportions of STR ≥50% in ECG and MBG2 in ticagrelor group were significantly higher than those in clopidogrel group (p<0.01). The incidence rate of mild bleeding in ticagrelor group was higher than that in clopidogrel group (p<0.05). CONCLUSIONS: The application of ticagrelor in the treatment of ST-elevated acute coronary syndrome accompanied by diabetes mellitus can increase the level of myocardial microcirculation perfusion and improve the left heart function.
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Ly et al. (2019) conducted an RCT in ST-elevated acute coronary syndrome accompanied by diabetes mellitus (n=210). Ticagrelor vs. Clopidogrel was evaluated on Myocardial microcirculation perfusion (STR and MBG) and myocardial necrosis markers (p=<0.01). Ticagrelor significantly improved myocardial microcirculation perfusion (P<0.01) and reduced myocardial necrosis markers (P<0.05) compared to clopidogrel in diabetic patients with STEMI.
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