Impact of preloading strategy with ticagrelor on periprocedural myocardial injury in patients with non-ST elevation myocardial infarction undergoing early invasive strategy

Abstract

Pretreatment with an oral P2Y12 receptor blocker (before coronary angiography) vs. treatment in the catheterization laboratory has been a matter of debate in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI). The primary aim of this study was to assess the impact of an immediate preloading strategy with ticagrelor on periprocedural myocardial injury in patients with NSTEMI treated with an early invasive strategy. NSTEMI patients who underwent coronary angiography and subsequent percutaneous coronary intervention (PCI) within 24 hours following hospital admission were divided into two groups: the first group (pretreatment group) included patients who received ticagrelor pretreatment as soon as possible after admission, and the second group (no-pretreatment group) included patients who received a loading dose of ticagrelor after coronary angiography. The pretreatment group included 232 patients, and the no-pretreatment group included 87 patients. Male patients represented the majority of the patients. The two groups were similar in terms of baseline characteristics, except for a greater incidence of hypertension (p=0.014) and higher haemoglobin levels (p=0.01) in the pretreatment group in comparison to no-pretreatment group. Patients in the ticagrelor pretreatment group had less myocardial injury until coronary angiography based on troponin measurements collected at 12. hour after admission (p=0.025). Patients in the ticagrelor pretreatment group also had fewer periprocedural myocardial injuries based on troponin measurements taken between 12. and 24. hours following the PCI (p=0.026 and p=0.022, respectively). Our findings suggested that ticagrelor pretreatment reduces periprocedural myocardial injury in NSTEMI patients who underwent PCI within 24 hours following admission.