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Angiographic and electrocardiographic parameters of myocardial reperfusion in angioplasty of patients with ST elevation acute myocardial infarction loaded with ticagrelor or clopidogrel ( MICAMI-TICLO trial ) . INTRODUCTION Ticagrelor has been shown to improve outcomes in patients with ACS . However , the effects of this drug on parameters of microvascular flow in patients presenting with ST-segment elevation myocardial infarction ( STEMI ) have not been completely evaluated . METHODS Ninety-two patients presenting with STEMI where randomized to a loading dose of clopidogrel ( 600 mg ) or ticagrelor ( 180 mg ) before undergoing primary angioplasty . We assessed angiographic and electrocardiographic parameters of myocardial reperfusion . Blinded operators calculated angiographic corrected TIMI Frame count ( cTFC ) and myocardial blush grade ( MBG ) before and after stent implantation . ST segment resolution was also measured in all patients . Primary endpoint was cTFC after PCI . Secondary endpoints were cTFC prior to PCI , TIMI flow grade , MBG and the percentage of ST resolution . RESULTS Of the 92 randomized patients , 70 patients were analyzed . Mean age of patients was 58.8±10 years . Patients presented with a mean ischemic time of 4.4±2.6 hours . There were no significant differences in the time between loading dose and stent deployment ( 35.2±36.4 in ticagrelor and 42.7±29.5 min in clopidogrel , p=0.36 ) . cTFC before angioplasty was significantly lower in ticagrelor than in clopidogrel ( 81.1±29.4 vs. 95.1±17.5 frames respectively , p=0.01 ) . After angioplasty there were no differences between ticagrelor and clopidogrel in cTFC ( 24.6±9.3 vs. 27.0±13.4 frames respectively , p=0.62 ) ; MBG grade 3 was present in 76.4 vs. 69.4 % of patients , respectively ( p=0.41 ) . The percentage of ST resolution did not show any differences between groups ( 84.8±23.4 in ticagrelor vs. 70.8±33.7 in clopidogrel , p=0.36 ) . CONCLUSION Compared with clopidogrel , ticagrelor loading in patients presenting with STEMI is not associated with an improvement of angiographic and electrocardiographic parameters of myocardial reperfusion after angioplasty .
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Intervention_Pharmacological
ticagrelor
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Intervention_Pharmacological
clopidogrel
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Intervention_Pharmacological
clopidogrel
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Intervention_Pharmacological
ticagrelor
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Intervention_Surgical
angioplasty
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Outcome_Physical
Angiographic and electrocardiographic parameters
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Outcome_Other
microvascular flow
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Outcome_Physical
angiographic and electrocardiographic parameters of myocardial reperfusion .
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Outcome_Other
angiographic corrected TIMI Frame count ( cTFC ) and myocardial blush grade ( MBG )
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Outcome_Other
ST segment resolution
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Outcome_Other
cTFC prior to PCI
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Outcome_Other
TIMI flow grade
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Outcome_Other
mean ischemic time
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Outcome_Other
the time between loading dose and stent deployment
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Outcome_Other
p=0.36
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Outcome_Other
cTFC
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Outcome_Other
clopidogrel in
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Outcome_Other
p=0.62
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Outcome_Other
p=0.41
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Outcome_Other
The percentage of ST resolution
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Outcome_Physical
improvement of angiographic and electrocardiographic parameters
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Participant_Condition
patients with ST elevation acute myocardial infarction
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Participant_Condition
ACS
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Participant_Condition
myocardial infarction ( STEMI )
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Participant_Sample-size
Ninety-two
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Participant_Sample-size
92 randomized patients
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Participant_Sample-size
70 patients
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Participant_Age
Mean age of patients was 58.8±10 years