Korean Circ J.  2017 Sep;47(5):705-713. 10.4070/kcj.2017.0044.

Comparison of the Infarct Size between the Loading of Ticagrelor and Clopidogrel in Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

• Yun KH
• Rhee SJ
• Ko JS

• KMID: 2389603
• DOI: http://doi.org/10.4070/kcj.2017.0044

Abstract

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.

Keyword

Angioplasty; Myocardial infarction; Blood platelets; Receptors, purinergic P2Y12

MeSH Terms

Angioplasty
Blood Platelets
Creatine
Humans
Myocardial Infarction*
Percutaneous Coronary Intervention*
Receptors, Purinergic P2Y12
Tomography, Emission-Computed
Tomography, Emission-Computed, Single-Photon
Troponin T
Creatine
Receptors, Purinergic P2Y12
Troponin T

Figure

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  Figure 1 Study flow chart. ICH = intracranial hemorrhage; MI = myocardial infarction; PCI = percutaneous coronary intervention; SPECT = single-photon emission computed tomography; STEMI = ST-segment elevation myocardial infarction.

• 

  Figure 2 Time-concentration curve of CK-MB isoenzyme and troponin T. CK-MB = creatine kinase-myocardial band.

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