The effect of ticagrelor based dual antiplatelet therapy on development of late left ventricular thrombus after acute anterior ST elevation myocardial infarction

Int J Cardiol. 2019 Jul 15:287:19-26. doi: 10.1016/j.ijcard.2019.04.010. Epub 2019 Apr 3.

Abstract

Aim: The aim of this study is to investigate the impact of ticagrelor as compared to clopidogrel based dual antiplatelet therapy (DAPT) during post-discharge management on the incidence of left ventricular (LV) thrombus in patients with first acute anterior ST elevation myocardial infarction (STEMI).

Method: 641 patients who met the inclusion criteria were divided into two groups based on the receipt of either ticagrelor or clopidogrel based DAPT.

Result: Left ventricular thrombus was detected in 73 (11.4%) patients at the first month echocardiographic examination. Ticagrelor based DAPT was associated with significantly less incidence of LV thrombus when compared to clopidogrel [20 (7.4%) vs 53 (14.0%) OR: 0.50 (0.29-0.86)]. Penalized maximum likelihood estimation (PMLE) logistic regression analyses were performed to fourteen candidate variables for identifying the independent predictors of LV thrombus, ticagrelor (compared with clopidogrel) [OR: 0.53 (0.28-0.96), p = 0.039], body mass index (BMI) [OR: 0.58 (0.44-0.77), p < 0.001], KILLIP class (I vs II-IV) [OR: 0.35 (0.14-0.83), p = 0.017], age [OR: 1.22 (1.08-1.40), p < 0.001], poor postprocedural myocardial blush grade (MBG) [OR: 3.35 (1.32-8.15), p = 0.012] and LVEF predischarge [OR: 0.79 (0.72-0.86), p < 0.001] were found to be associated with LV thrombus.

Conclusion: Our study demonstrated that the incidence of LV trombus was significantly lower with ticagrelor than clopidogrel-based DAPT during postdischarge treatment for anterior STEMI patients.

Keywords: Anterior ST elevation myocardial infarction; Clopidogrel; Dual antiplatelet therapy; Left ventricular thrombus; Ticagrelor.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Anterior Wall Myocardial Infarction / complications*
  • Anterior Wall Myocardial Infarction / diagnosis
  • Anterior Wall Myocardial Infarction / drug therapy
  • Aspirin / administration & dosage
  • Clopidogrel / administration & dosage*
  • Coronary Angiography
  • Dose-Response Relationship, Drug
  • Dual Anti-Platelet Therapy / methods*
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Heart Diseases / epidemiology
  • Heart Diseases / etiology
  • Heart Diseases / prevention & control*
  • Heart Ventricles
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / administration & dosage
  • Purinergic P2Y Receptor Antagonists / administration & dosage
  • Retrospective Studies
  • ST Elevation Myocardial Infarction / complications*
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / drug therapy
  • Thrombosis / epidemiology
  • Thrombosis / etiology
  • Thrombosis / prevention & control*
  • Ticagrelor / administration & dosage*
  • Treatment Outcome
  • Turkey / epidemiology

Substances

  • Platelet Aggregation Inhibitors
  • Purinergic P2Y Receptor Antagonists
  • Clopidogrel
  • Ticagrelor
  • Aspirin