Ticagrelor Versus Clopidogrel for CMD in Patients With AMI: A Retrospective Study Based on the Angio-IMR

Second Affiliated Hospital, School of Medicine, Zhejiang University325 enrolled

Overview

Coronary microvascular dysfunction (CMD) is increasingly recognized as an important indicator for long-term prognosis in patients with acute myocardial infarction (AMI). The angiography-derived index of microcirculatory resistance (angio-IMR) is a novel guidewire-free measure for CMD in patients with AMI. Ticagrelor has recently been suggested to have additional benefits on coronary microcirculation beyond its antiplatelet effect. This study was designed to compare the protective effects of ticagrelor and clopidogrel on CMD and prognostic impact in patients with AMI, using the angio-IMR as a novel assessment tool.

Study Type

OBSERVATIONAL

Enrollment

325

Conditions

Coronary Heart Disease

Interventions

Dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrelDRUG

Patients with acute myocardial infarction randomly received dual antiplatelet therapy with with aspirin 100mg daily and either ticagrelor 90mg twice daily or clopidogrel 75mg once daily for at least 9 months after PCI as needed.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients who were diagnosed with AMI, including STEMI and NSTEMI, and underwent successful PCI and routine follow-up coronary angiography at the Second Affiliated Hospital of Zhejiang University School of Medicine between June 1, 2017 and May 31, 2020. Exclusion Criteria: * 1\) prior treatment with any P2Y12 inhibitor; * 2\) need for long-term oral anticoagulation therapy; * 3\) previous coronary artery bypass grafting (CABG); * 4\) chronic renal dysfunction with estimated glomerular filtration rate (eGFR) \<30 mL/ (min·1.73 m2) or on hemodialysis; * 5\) liver cirrhosis ≥Child-Pugh B class; * 6\) cancer; * 7\) adjustment of dual antiplatelet therapy (DAPT) during follow-up; * 8\) inadequate coronary angiographic images.

Outcomes

Primary Outcomes

The improvement of angio-IMR

Difference between Angio-IMR at follow-up coronary angiography and Angio-IMR after PCI

Time frame: within 24 months post-PCI