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Pre-hospital loading with ticagrelor/prasugrel trumps clopidogrel in STEMI patients

28 Jun 2020

Pre-hospital loading with ticagrelor or prasugrel reduces infarct size and greater myocardial salvage index in patients with ST-elevation myocardial infarction (STEMI) relative to clopidogrel, a recent study has found.

The study included STEMI patients who were loaded with either clopidogrel (n=351; mean age, 58.8±10.6 years) or ticagrelor/prasugrel (n=342; mean age, 57.8±10.4 years) in the ambulance before receiving primary percutaneous coronary injury. Cardiac magnetic resonance (CMR) was used in the calculation of infarct size and the myocardial salvage index. Outcomes were measured at baseline and after 3 months.

At baseline, all CMR findings were comparable between the clopidogrel and ticagrelor/prasugrel groups, except for left ventricular mass index, which was significantly higher in the latter group (p=0.002).

By the 3-month follow-up, infarct size was significantly lower in the ticagrelor/prasugrel group (10.0 vs 12.9 percent of left ventricular mass; p<0.001), while the myocardial salvage index was significantly higher (71 percent vs 66 percent; p<0.001). Left ventricular mass index remained significantly elevated in the ticagrelor/prasugrel group (p=0.003).

These differences were reported despite no significant gaps in the time to CMR between the clopidogrel and ticagrelor/prasugrel groups (p=0.18). Agent choice had no significant effect on left ventricular ejection fraction, and left ventricular end-diastolic and end-systolic volume indices.

“This is a retrospective study with non-prespecified sub-analysis. Antiplatelet treatment was not randomized. No specific data were available on the timing of loading in relation to symptom onset and time of wiring/PCI,” the researchers said, referring to the study’s limitations.

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Most Read Articles
Elaine Soliven, 3 days ago

Switching from efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF) to the new bictegravir/ emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) regimen maintained high rates of virological suppression in adults who are living with HIV*, according to a study presented at AIDS 2020.

01 Aug 2020
Supplementation with probiotics may have positive effects in patients with type 2 diabetes mellitus (T2DM), reports a recent meta-analysis.
Stephen Padilla, 4 days ago
Pre-exposure prophylaxis (PrEP) containing either long-acting injectable cabotegravir (CAB) or tenofovir/emtricitabine (TDF/FTC) is safe and effective for transgender women (TGW) and cisgender men who have sex with men (MSM), but CAB results in a much lower HIV incidence compared to TDF/FTC, results of the HIV Prevention Trials Network (HPTN) 083 have shown.
Jairia Dela Cruz, 3 days ago
Monthly prophylaxis with the fixed-dose combination of naphthoquine-azithromycin (NQAZ) is well tolerated and confers significant protection against infection with Plasmodium parasites among individuals residing in malaria-endemic areas in Southeast Asia, as shown in the results of a phase III trial.