Use of ticagrelor may provide improved myocardial protection compared to clopidogrel in pharmaco-invasive ST-segment elevation myocardial infarction

1. Ticagrelor led to a smaller 30-day cardiac magnetic resonance (CMR)-defined infarct size than clopidogrel in pharmaco-invasive STEMI

Evidence Rating Level: 1 (Excellent) 

This randomized, open-label BATTLE-AMI trial evaluated whether ticagrelor reduces infarct size compared with clopidogrel in ST-segment elevation myocardial infarction (STEMI) patients treated with a pharmaco-invasive strategy. Adults (n=225) who received tenecteplase within 6 hours of symptom onset and underwent coronary angiography/PCI within 24 hours were randomized 1:1 to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily, in addition to guideline-directed therapy. Cardiac magnetic resonance at 30 days was the primary endpoint. Baseline clinical and angiographic characteristics and reperfusion timings were comparable. Ticagrelor was associated with significantly smaller infarcted LV mass (median 12 g vs 17 g; 11% vs 16% LV mass; p=0.012 and p=0.008) and a trend to higher LVEF, despite similar TIMI flow, myocardial blush, and concomitant therapies. Early hs-troponin T and hs-CRP were lower with ticagrelor, suggesting less myocardial injury and inflammation. However, the study was not powered for clinical events and follow-up was limited to 30 days. The authors conclude ticagrelor may confer myocardial protection beyond platelet inhibition in pharmaco-invasively managed STEMI.

Click here to read this study in PLOS One

Image: PD

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