Smaller Infarct Size with Ticagrelor vs. Clopidogrel in STEMI Patients
A randomized, open-label BATTLE-AMI trial explored whether ticagrelor reduces infarct size compared to clopidogrel in patients with ST-segment elevation myocardial infarction (STEMI) treated using a pharmaco-invasive strategy.
Study Design
- 225 adults who received tenecteplase within 6 hours of symptom onset
- Coronary angiography or PCI performed within 24 hours
- Randomized 1:1 to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily, plus guideline-based therapy
- Primary endpoint: infarct size assessed by cardiac magnetic resonance (CMR) at 30 days
Key Findings
- Ticagrelor was linked to significantly smaller infarcted left ventricular (LV) mass: median 12 g vs. 17 g, representing 11% vs. 16% of LV mass (p=0.012 and p=0.008)
- A trend toward higher left ventricular ejection fraction (LVEF) was observed with ticagrelor
- Similar TIMI flow grades, myocardial blush, and other therapies were noted between groups
- Lower early levels of high-sensitivity troponin T and high-sensitivity C-reactive protein (hs-CRP) with ticagrelor suggested reduced myocardial injury and inflammation
Interpretation and Limitations
The study indicates ticagrelor may offer myocardial protection beyond just platelet inhibition in pharmaco-invasively treated STEMI patients.
The authors conclude ticagrelor may confer myocardial protection beyond platelet inhibition in pharmaco-invasively managed STEMI.
However, the trial was not powered to assess clinical events and only included a 30-day follow-up period.
Evidence Rating
Level 1 (Excellent)
Source
©2025 2 Minute Medicine, Inc.
Author's Summary: Ticagrelor reduces infarct size and myocardial injury markers compared to clopidogrel in early STEMI treatment, suggesting additional heart protection effects beyond platelet inhibition.