Smaller infarct size with ticagrelor vs. clopidogrel in STEMI patients: Insights from cardiac magnetic resonance

Smaller Infarct Size with Ticagrelor vs. Clopidogrel in STEMI Patients

A randomized, open-label trial, BATTLE-AMI, assessed the effect of ticagrelor compared to clopidogrel on infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated using a pharmaco-invasive approach.

Study Design and Population

225 adults who received tenecteplase within 6 hours of symptom onset were enrolled.
All underwent coronary angiography or percutaneous coronary intervention (PCI) within 24 hours.
Participants were randomized 1:1 to ticagrelor 90 mg twice daily or clopidogrel 75 mg daily, alongside standard guideline-based therapy.

Primary Endpoint and Results

The primary endpoint was infarct size measured by cardiac magnetic resonance imaging (CMR) at 30 days.

Ticagrelor resulted in a significantly smaller infarcted left ventricular (LV) mass (median 12 g vs. 17 g; 11% vs. 16% of LV mass; p=0.012 and p=0.008).
There was a trend toward higher left ventricular ejection fraction (LVEF) with ticagrelor.
TICagrelor and clopidogrel groups showed similar TIMI flow and myocardial blush grades, indicating comparable reperfusion quality.
Early biomarkers, including high-sensitivity troponin T (hs-troponin T) and high-sensitivity C-reactive protein (hs-CRP), were lower in the ticagrelor group, suggesting less myocardial injury and inflammation.

Limitations and Conclusions

The study was not powered to assess clinical events and had a limited follow-up of 30 days.

The authors conclude ticagrelor may provide myocardial protection beyond platelet inhibition in pharmaco-invasively treated STEMI patients.

These findings suggest that ticagrelor could offer superior cardiac tissue preservation compared to clopidogrel in this setting.

Evidence Rating

Level 1 (Excellent)

Summary: Ticagrelor reduces infarct size and myocardial injury markers compared to clopidogrel in STEMI patients undergoing pharmaco-invasive treatment, potentially providing additional myocardial protection.

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2 Minute Medicine — 2025-11-07