Author + information
- Ling-Xia Xu,
- Kang-Yin Chen,
- Tong Liu,
- Xin-Tian Zheng,
- Jing-Jin Che and
- Guangping Li
Periprocedural myocardial infarction (PMI) is a common complication following percutaneous coronary intervention (PCI). The present study was aimed to evaluate the safety and efficacy of loading dose of ticagrelor versus clopidogrel in preventing PMI in patients with acute coronary syndrome (ACS) undergoing selective PCI.
The present study enrolled a total of 114 patients with ACS who underwent selective PCI from Jun 2014 to November 2015 in Cardiology Department of the Second Hospital of Tianjin Medical University. All patients were randomly assigned to clopidogrel group (n=57, the loading and maintenance doses were 300mg and 75mg Qd for clopidogrel, and 300mg and 100mg Qd for aspirin), or ticagrelor group (n=57, the loading and maintenance doses were 180mg and 90mg Bid for ticagrelor, and 300mg and 100mg Qd for aspirin). In the present study, 2 subgroup analyses were preformed: 1) antiplatelet-treated subgroup (n=61): we evaluated the impact of loading doses of ticagrelor (vs clopidogrel) on PMI in the antiplatelet-treated patients; 2) antiplatelet-naive subgroup (n=53): we analyzed the effects of ticagrelor (vs clopidogrel) on PMI in patients who didn't receive antiplatelet treatment. The cardiac troponin I (cTnI), creatine kinase-MB (CK-MB) and high-sensitive C-reactive protein (hs-CRP) were determined before, and 8, 24 hours after PCI. All patients received standard diagnostic angiography and PCI procedure. And drug-eluting stents (DESs) were deployed after prior balloon angioplasty. The use of platelet glycoprotein (GP) IIb/IIIa receptor antagonists was a decision of individual operator. Patients in the ticagrelor group received aspirin and ticagrelor for 1 week, then changed to use aspirin and clopidogrel.
Baseline clinical, angiographic and PCI procedural characteristics were similar between the two groups except that ticagrelor group had more male patients (p=0.045), higher use rate of β-blockers (p=0.034) than did clopidogrel group. The overall incidence of PMI was 37.7%. Ticagrelor group showed a significantly lower incidence of PMI compared to clopidogrel group (28.1% vs 47.4%, p=0.034). However, subgroup analyses showed that the incidences of PMI were comparable between ticagrelor group and clopidogrel group regardless antiplatelet-treated or not (antiplatelet-naive group: 24.0% vs 42.9%, p=0.148; antiplatelet-treated group: 31.2% vs 51.7%, p=0.104). In addition, the levels of hs-CRP before and after PCI were similar between the comparing groups. Multivariable logistic analysis performed in the overall study population showed that the use of ticagrelor [hazard ratio (HR): 0.35; 95% confidence interval (CI): 0.15-0.82; p=0.016] was an independent predictor of PMI.
Pretreatment with the loading dose of ticagrelor can significantly lower the incidence of PCI related PMI in patients with ACS underoing selective PCI as compared with clopidogrel. Further study with larger study population is needed to get definite conclusions.