Yonsei Med J.  2018 Jul;59(5):624-632. 10.3349/ymj.2018.59.5.624.

Randomized Comparison of Strut Coverage between Ticagrelor and Clopidogrel in Acute Myocardial Infarction at 3-Month Optical Coherence Tomography

• Kim C
• Kim BK
• Hong SJ
• Ahn CM
• Kim JS
• Ko YG
• Choi D
• Hong MK
• Jang Y

• KMID: 2412653
• DOI: http://doi.org/10.3349/ymj.2018.59.5.624

Abstract

PURPOSE
This study aimed to compare the effects of ticagrelor and clopidogrel on early neointimal healing assessed with optical coherence tomography (OCT) after drug-eluting stent (DES) implantation in patients with acute myocardial infarction (AMI).
MATERIALS AND METHODS
AMI patients were randomly assigned to either the ticagrelor or clopidogrel arm. After DES implantation, OCT was performed to assess the percentages of uncovered struts immediately after procedure and 3 months later.
RESULTS
Due to early termination, 83 patients out of 106 initially enrolled patients (24% of planned participants) underwent 3-month OCT. Differences in vascular healing patterns between the two groups, including percentage of uncovered struts on 3-month OCT (9.6% vs. 11.7% in ticagrelor vs. clopidogrel, respectively; p=0.867), neointimal thickness, percentage of malapposed struts, and healing scores did not reach statistical significance. The predictors of uncovered strut on 3-month OCT included greater reference vessel diameter [odds ratio (OR)=1.96, p < 0.001] and more malapposed struts (OR=1.12, p=0.003).
CONCLUSION
The current study did not explore favorable effect of ticagrelor on 3-month vascular healing after DES implantation. Our findings should only be considered for generating hypothesis, due to insufficient power.

Keyword

Neointima; tomography; optical coherence; myocardial infarction; ticagrelor; clopidogrel

MeSH Terms

Arm
Drug-Eluting Stents
Humans
Myocardial Infarction*
Neointima
Tomography, Optical Coherence*

Figure

• 

  Fig. 1 Study design and flow of patient inclusion. AMI, acute myocardial infarction; PCI, percutaneous coronary intervention; OCT, optical coherence tomography.

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  Fig. 2 Comparisons of strut coverage between ticagrelor and clopidogrel: (A) uncovered strut, (B) neointimal thickness, (C) cross-sections with uncovered strut, and (D) cross-sections with uncovered strut >3. Thick lines within boxes represent median value; upper and lower margins of boxes represent 25th and 75th percentiles, respectively; and upper and lower bars represent 90th and 10th percentiles, respectively.

• 

  Fig. 3 Cumulative distribution of optical coherence tomography healing scores. IQR, interquartile range.

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  Fig. 4 Stent coverage and procedural predictors. Thick lines within boxes represent median value; upper and lower margins of boxes represent 25th and 75th percentiles, respectively; and upper and lower bars represent 90th and 10th percentiles, respectively.

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