Pharmacological Evaluation of Ticagrelor and Aspirin Versus Clopidogrel and Aspirin Pretreatment on Infarct Artery Flow in Patients with Acute STEMI

Pharmacological Evaluation of Ticagrelor and Aspirin Versus Clopidogrel and Aspirin Pretreatment on Infarct Artery Flowin Patients with Acute STEMI Pharmaceuticals 2025, 18(12), 1856; https://doi.org/10.3390/ph18121856AbstractBackground and Objectives: Dual antiplatelet therapy(DAPT) with aspirin and a P2Y12 inhibitor is standard in ST-segment elevation myocardial infarction (STEMI). Guidelines favor ticagrelor over clopidogrel, but their effect on infarct artery flow prior to percutaneous coronary intervention(PCI) remains debated. Objective was to compare the effects of aspirin + clopidogrel versus aspirin + ticagrelor pretreatment on infarct arteryThrombolysis in Myocardial Infarction (TIMI) flow in ST-segment elevation myocardial infarction patients. Materials and Methods: This retrospective cohortstudy included first-time ST-segment elevation myocardial infarction patients ≥ 18 years admitted to the Military Medical Academy, Belgrade (January 2016–January 2022), who received pretreatment with aspirin + clopidogrel or aspirin + ticagrelor and underwent percutaneous coronary intervention. Thrombolysis in Myocardial Infarction flow was graded  before and after percutaneous coronary intervention. Primary outcomes were pre- and post- percutaneous coronary intervention Thrombolysis in Myocardial Infarctionflow; secondary outcome was in-hospital mortality. Results: Of 299 ST-segment elevation myocardialinfarction patients, 174 received aspirin + ticagrelor and 125 received aspirin + clopidogrel. Pre- percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow was significantly higher in the ticagrelor group (p < 0.001), whilepost- percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow (p = 0.056) and in-hospital mortality (p = 0.083) did not significantly differ between groups. After exclusion of patients receiving glycoprotein IIb/IIIa  inhibitors, the difference in percutaneous coronary intervention Thrombolysis in Myocardial Infarction flow grade after percutaneous coronary intervention becamestatistically significant (p = 0.007), favoring the aspirin + ticagrelor group. In multivariate analysis, male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitor use were independently associated with reduced in-hospitalmortality. Conclusions: In ST-segment elevation myocardial infarction patients, ticagrelor-based Dual antiplatelet therapy was associated with better initial coronary flow compared to clopidogrel. However, this advantage was not evident after percutaneous coronary intervention. Male gender, drug-eluting stent implantation, and glycoprotein IIb/IIIa inhibitoruse were associated with improved survival.Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.