Effect of Ticagrelor on Left Ventricular Remodeling in Patients With ST-Segment Elevation Myocardial Infarction (HEALING-AMI)
Yongwhi Park, Jin Sin Koh, Jae-Hwan Lee, Jae-Hyeong Park, Eun-Seok Shin, Ju Hyeon Oh, Woojung Chun, Sang Yeub Lee, Jang-Whan Bae, Jeong Su Kim, Weon Kim, Jung-Won Suh, Dong Heon Yang, Young-Joon Hong, Mark Y Chan, Min Gyu Kang, Hyun-Woong Park, Seok-Jae Hwang, Jin-Yong Hwang, Jong-Hwa Ahn, Si Wan Choi, Young-Hoon Jeong, HEALING-AMI Investigators, Yongwhi Park, Choong Hwan Kwak, Young-Hoon Jeong, Jin-Sin Koh, Seok-Jae Hwang, Jin-Yong Hwang, Hyun-Woong Park, Min Gyu Kang, Jeong Rang Park, Kyehwan Kim, Jin Hyun Kim, Jae-Hyeong Park, In-Whan Seong, Si-Wan Choi, Jae-Hwan Lee, Eun Seok Shin, Soe Hee Ann, Shin Jae Kim, Ju Hyeon Oh, Woojung Chun, Gu Hyun Kang, Mi Rae Lee, Woo Jin Jang, Yong Hwan Park, Sang Yeub Lee, Jang-Whan Bae, Sang Min Kim, Chung Suk Lee, Jeongsu Kim, June Hong Kim, Kook Jin Chun, Min Gu Chon, Sang Hyun Lee, Weon Kim, Woo-Shik Kim, Jin-Bae Kim, Jong-Shin Woo, Jung-Won Suh, In-Ho Chae, Tae-Jin Youn, Young Seok Cho, Chang-Hwan Yoon, Jin Joo Park, Si-Hyuck Kang, Euijae Lee, Donghoon Kim, Jeehoon Kang, Dong Heon Yang, Nam Kyun Ki, Jang Hoon Lee, Young Joon Hong, Jaeyeong Cho, Min Chul Kim, Doo Sun Sim, Mark Y Chan, Stephanie Marchesseau, Yongwhi Park, Jin Sin Koh, Jae-Hwan Lee, Jae-Hyeong Park, Eun-Seok Shin, Ju Hyeon Oh, Woojung Chun, Sang Yeub Lee, Jang-Whan Bae, Jeong Su Kim, Weon Kim, Jung-Won Suh, Dong Heon Yang, Young-Joon Hong, Mark Y Chan, Min Gyu Kang, Hyun-Woong Park, Seok-Jae Hwang, Jin-Yong Hwang, Jong-Hwa Ahn, Si Wan Choi, Young-Hoon Jeong, HEALING-AMI Investigators, Yongwhi Park, Choong Hwan Kwak, Young-Hoon Jeong, Jin-Sin Koh, Seok-Jae Hwang, Jin-Yong Hwang, Hyun-Woong Park, Min Gyu Kang, Jeong Rang Park, Kyehwan Kim, Jin Hyun Kim, Jae-Hyeong Park, In-Whan Seong, Si-Wan Choi, Jae-Hwan Lee, Eun Seok Shin, Soe Hee Ann, Shin Jae Kim, Ju Hyeon Oh, Woojung Chun, Gu Hyun Kang, Mi Rae Lee, Woo Jin Jang, Yong Hwan Park, Sang Yeub Lee, Jang-Whan Bae, Sang Min Kim, Chung Suk Lee, Jeongsu Kim, June Hong Kim, Kook Jin Chun, Min Gu Chon, Sang Hyun Lee, Weon Kim, Woo-Shik Kim, Jin-Bae Kim, Jong-Shin Woo, Jung-Won Suh, In-Ho Chae, Tae-Jin Youn, Young Seok Cho, Chang-Hwan Yoon, Jin Joo Park, Si-Hyuck Kang, Euijae Lee, Donghoon Kim, Jeehoon Kang, Dong Heon Yang, Nam Kyun Ki, Jang Hoon Lee, Young Joon Hong, Jaeyeong Cho, Min Chul Kim, Doo Sun Sim, Mark Y Chan, Stephanie Marchesseau
Abstract
Objectives: The aim of this study was to evaluate the effect of ticagrelor versus clopidogrel on left ventricular (LV) remodeling after reperfusion of ST-segment elevation myocardial infarction (STEMI) in humans.
Background: Animal studies have demonstrated that ticagrelor compared with clopidogrel better protects myocardium against reperfusion injury and improves remodeling after myocardial infarction.
Methods: In this investigator-initiated, randomized, open-label, assessor-blinded trial performed at 10 centers in Korea, patients were enrolled if they had naive STEMI successfully treated with primary percutaneous coronary intervention (PCI) and at least 6-month planned duration of dual-antiplatelet treatment. The coprimary endpoints were LV remodeling index (LVRI) (a relative change of LV end-diastolic volume) measured on 3-dimensional echocardiography and N-terminal pro-B-type natriuretic peptide level at 6 months.
Results: Among initially enrolled patients with STEMI (n = 336), 139 in each group completed the study. LVRI at 6 months was numerically lower with ticagrelor versus clopidogrel (0.6 ± 18.6% vs. 4.5 ± 16.5%; p = 0.095). Ticagrelor 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. By multivariate analysis, ticagrelor versus clopidogrel reduced the risk for positive LV remodeling (LVRI >0%) (odds ratio: 0.56; 95% confidence interval: 0.33 to 0.95; p = 0.030). The LV end-diastolic volume index remained unchanged during ticagrelor treatment (from 54.7 ± 12.2 to 54.2 ± 12.2 ml/m2; p = 0.629), but this value increased over time during clopidogrel treatment (from 54.6 ± 11.3 to 56.4 ± 13.9 ml/m2; p = 0.056) (difference -2.3 ml/m2; 95% confidence interval: -4.8 to 0.2 ml/m2; p = 0.073). Ticagrelor reduced LV end-systolic volume index (from 27.0 ± 8.5 to 24.7 ± 8.4 ml/m2; p < 0.001), whereas no reduction was seen with clopidogrel (from 26.2 ± 8.9 to 25.6 ± 11.0 ml/m2; p = 0.366) (difference -1.8 ml/m2; 95% confidence interval: -3.5 to -0.1 ml/m2; p = 0.040).
Conclusions: Ticagrelor was superior to clopidogrel for LV remodeling after reperfusion of STEMI with primary PCI. (High Platelet Inhibition With Ticagrelor to Improve Left Ventricular Remodeling in Patients With ST Segment Elevation Myocardial Infarction [HEALING-AMI]; NCT02224534).
Keywords: clopidogrel; myocardial infarction; platelet; remodeling; ticagrelor.
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed