Observation of ticagrelor efficacy in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

Abstract

Objective To explore the efficacy and safety of ticagrelor in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Methods Our research was a single center, randomized, prospective, controlled study. The 207 patients with STEMI undergoing primary percutaneous coronary intervention (PCI) were randomly divided into two groups: 101 patients in the observation group and 106 patients in the control group. Before coronary angiography, the observation group was given 300 mg loading dose aspirin and ticagrelor 180 mg, while the control group received 300 mg loading dose of aspirin and clopidogrel 600 mg. The coronary angiography was performed through radial or femoral arteries. Patients in both groups were given 2 000-10 000 IU heparin intravenously for anticoagulation treatment. After PCI, patients in observation group were given ticagrelor 90 mg bid, and those in control group were given clopidogrel 75 mg qd for 12 months. Results A total of 3 patients were excluded (not eligible for PCI, 1 in observation group and 2 in control group) and 5 cases had been lost during the 1-year follow-up (2 in observation group and 3 in control group). There was no significant difference in TIMI 3 grade between the two groups [86.7% (85/98) in observation group vs. 77.2% (78/101) in control group, P>0.05]. CTFC and in-stent thrombosis were similar in the two groups. LVEF and LVEDD were improved at 1- and 12-month in all patients, and there were better effects in the observation group (P=0.04, 0.03) in one year. After 24 h treatment, the observation group had better platelet inhibition effect than control group (P=0.04). MACE rate was 15.3% in observation group and 28.7% in control group (P=0.02). The incidence of bleeding in two groups were similar (P>0.05). Conclusions Ticagrelor can be more effective in inhibiting platelet aggregation compared with clopidogrel in the treatment of STEMI undergoing PCI. It is possible that ticagrelor can reduce the rate of MACE without increasing major incidence of fatal and other major bleeding. Key words: Acute ST-segment elevation myocardial infarction; Angioplasty, transluminal, percutaneous coronary; Ticagrelor; Clopidogrel