Comparison of the Efficacy in No-Reflow Prevention Between Ticagrelor and Clopidogrel in Diabetic Patients With STEMI

Even when epicardial blood flow is restored, achieving adequate perfusion to the microvascular level is the goal. The generous utilization of antithrombotics may facilitate bleeding. We aimed to compare the efficacy in preventing no-reflow between ticagrelor and traditional loading with clopidogrel in diabetic patients presenting with ST-segment-elevation myocardial infarction (STEMI) and to assess the safety of ticagrelor administration regarding the short-term bleeding risk.
 
The present single-center prospective randomized trial consecutively randomized 300 diabetic patients admitted to the emergency department with STEMI into 2 groups: ticagrelor and clopidogrel. All the patients underwent primary percutaneous coronary intervention (PCI), during which the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG) were recorded. We followed up on the patients for 3 months to detect short-term major adverse cardiovascular events (MACE) and bleeding events.
 
The mean age of the studied population was 56 years, with a male predominance (70%). The median pain-to-door time was 8 hours. The no-reflow phenomenon was encountered more frequently in the clopidogrel group than in the ticagrelor group (37.3% vs 14%). Higher TIMI flow grades and MBGs were achieved in the ticagrelor group, and the difference was statistically significant. No significant differences, however, existed between the groups concerning MACE, stent thrombosis, and mortality. More bleeding episodes were recorded in the ticagrelor group but with no statistical significance.
 
Ticagrelor should be the first choice among P2Y12 inhibitors in the setting of primary PCI, especially in diabetic patients, due to its high efficacy and safety profile, even in elderly patients. (Iranian Heart Journal 2023; 24(4): 14-25)