Objective. Primary percutaneous coronary intervention (PCI) is the best treatment for acute ST-elevation myocardial infarction (STEMI). Evidence is in favor of ticagrelor over clopidegrel in STEMI patients regarding the reduction of stent thrombosis risk during and after PCI. We compared initial thrombolysis in myocardial infarction (TIMI) flow in STEMI patients on ticagrelor vs. clopidogrel. Methods. This prospective cohort recruited 160 patients with acute STEMI, referred to the emergency department of Farshchian Heart Center, during March 2018–2019. Before angiography, the patients received clopidogrel (600 mg) or ticagrelor (180 mg) on top of aspirin. Initial TIMI flow was compared between the two groups as the primary outcome. A logistic regression was performed to calculate the predictors of initial TIMI flow. Analyses were performed using R, version 4.2.1. Results. In ticagrelor and clopidogrel groups, the mean ± standard deviation age of the patients was 59.46 ± 13.11 and 61.34 ± 11.08 years ( value = 0.33), respectively. In the ticagrelor and clopidogrel groups, initial TIMI flow grades were as follows: 0 : 50% and 71.2%, I: 26.2% and 16.2%, II: 12.5% and 10%, and III: 12.9% and 2.5%, respectively ( value = 0.005). Final TIMI flow grades were as follows: I: 26.2% and 16.2%, II: 7.5% and 13.8%, and III: 66.3% and 70%, respectively ( value = 0.41). Ticagrelor was associated with significantly higher initial TIMI flow grade compared to the clopidogrel group (adjusted odds ratio: 2.90 (95% CI: 1.51–5.72)). Conclusion. In STEMI patients who were candidates for primary PCI, ticagrelor administration led to a better initial TIMI flow grade compared to clopidogrel.

中文翻译：

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急性 ST 段抬高型心肌梗死患者在接受初次经皮冠状动脉介入治疗前接受替格瑞洛与氯吡格雷治疗时初始 TIMI 血流分级的比较：一项前瞻性队列研究

客观的。直接经皮冠状动脉介入治疗（PCI）是急性 ST 段抬高型心肌梗死（STEMI）的最佳治疗方法。对于 STEMI 患者，在 PCI 期间和术后支架内血栓形成风险降低方面，有证据支持替格瑞洛优于氯吡格雷。我们比较了 STEMI 患者服用替格瑞洛与氯吡格雷时心肌梗死 (TIMI) 流量的初始溶栓情况。方法。该前瞻性队列招募了 2018 年 3 月至 2019 年 3 月转诊至 Farshchian 心脏中心急诊科的 160 名急性 STEMI 患者。血管造影前，患者在阿司匹林的基础上接受氯吡格雷（600 mg）或替格瑞洛（180 mg）治疗。比较两组之间的初始 TIMI 流量作为主要结果。进行逻辑回归来计算初始 TIMI 流的预测因子。使用 R 版本 4.2.1 进行分析。结果。在替格瑞洛和氯吡格雷组中，患者的平均±标准差年龄分别为59.46±13.11和61.34±11.08岁（值=0.33）。在替格瑞洛组和氯吡格雷组中，初始 TIMI 血流分级如下：分别为 0：50% 和 71.2%，I：26.2% 和 16.2%，II：12.5% 和 10%，III：12.9% 和 2.5%（值 = 0.005)。最终TIMI流动等级如下：I：26.2％和16.2％，II：7.5％和13.8％，III：66.3％和70％（值= 0.41）。与氯吡格雷组相比，替格瑞洛与显着较高的初始 TIMI 血流分级相关（调整后的比值比：2.90（95% CI：1.51-5.72））。结论。在适合直接 PCI 的 STEMI 患者中，与氯吡格雷相比，替格瑞洛给药可带来更好的初始 TIMI 血流分级。