- NEWS . 26 Oct 2020
Ticagrelor improves LV remodelling in post-PCI STEMI patients
Ticagrelor showed superiority to clopidogrel for left ventricular (LV) remodelling after reperfusion of ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI). This is according to the HEALING-AMI trial (High Platelet Inhibition with Ticagrelor to Improve Left Ventricular Remodeling in Patients With ST Segment Elevation Myocardial Infarction), an investigator-initiated, randomized, open-label, assessor-blinded trial performed at 10 centres in Korea.
The study enrolled patients with naive STEMI successfully treated with PCI and had at least 6 months’ planned duration of dual antiplatelet treatment. The coprimary endpoints were LV remodelling index (LVRI; a relative change of LV end-diastolic volume) and N-terminal pro-B-type natriuretic peptide level at 6 months.
Results showed that ticagrelor compared with clopidogrel resulted in a numerically lower LVRI at 6 months (0.6±18.6% vs 4.5±16.5%; p=0.095), and also significantly reduced the 6-month level of N-terminal pro-B-type natriuretic peptide (173±141 pg/mL vs 289±585 pg/mL; p=0.028). These differences were prominent in patients with pre-PCI TIMI (Thrombolysis In Myocardial Infarction) flow grade 0. After multivariate analysis, ticagrelor versus clopidogrel significantly reduced the risk of positive LV remodelling (LVRI >0%; odds ratio, 0.56; 95% confidence interval, 0.33–0.95; p=0.030). The LV end-diastolic volume index remained unchanged during ticagrelor treatment, whereas this value increased over time during clopidogrel treatment. Lastly, ticagrelor significantly reduced LV end-systolic volume index, whereas no significant reduction was seen with clopidogrel.
Park Y, et al. Effect of ticagrelor on left ventricular remodeling in patients with ST-segment elevation myocardial infarction (HEALING-AMI). JACC Cardiovasc Interv 2020;13:2220-2234.