Impact of oral P2Y12 inhibitors on residual thrombus burden and reperfusion indexes in patients with ST-segment elevation myocardial infarction

Effectiveness of Different P2Y12 Inhibitors on Coronary Flow in Patients with ST-Elevation Myocardial Infarction

Background: ST-segment elevation myocardial infarction (STEMI) is a clinical syndrome with high mortality. The main purpose of STEMI treatment is to achieve optimal revascularization for tissue perfusion. Besides the innovations in revascularization strategies, developments in antithrombotic therapy resulted in a significant reduction in STEMI-related mortality. Reperfusion can be demonstrated by resolution of ST-segment elevation (STR), TIMI frame count (TFC), and myocardial blush grade (MBG). Aim of the study: In our study, we investigated the effects of P2Y12 inhibitors clopidogrel, prasugrel, and ticagrelor on reperfusion parameters such as TFC, MBG, and STR, after primary percutaneous coronary intervention (pPCI) in STEMI.

Material and Methods: The study was a retrospective analysis of STEMI patients who underwent successful pPCI. A total of 120 patients were included in the study as 3 equal groups according to the type of P2Y12 inhibitor administered in loading dose in the acute phase, and reperfusion parameters were compared between the groups.

Results: There was no statistically significant difference between the groups in terms of baseline demographic, clinical, and angiographic parameters. Evaluation of reperfusion parameters indicated that STR, MBG, angina relief after pPCI and corrected TFC (cTFC) were significantly different between the groups (p <0.05). In post-hoc analysis, the percentage of change in STR, MBG, angina relief after pPCI, and cTFC was significantly higher in the prasugrel group (p <0.017).

Conclusion: In STEMI patients undergoing pPCI, the analysis of tissue level reperfusion parameters indicates a superior effect of prasugrel compared with other P2Y12 inhibitors used to achieve reperfusion.

Ticagrelor versus clopidogrel in the management of acute myocardial infarction

Hypothesis: In the care of acute myocardial infarction, ticagrelor attenuates post-ischemic myocardial damage and inhibits platelet activity to a greater extent than clopidogrel. Methods: Scholarly articles published in the last 10 years were compiled from a PubMed MeSH search focusing on acute coronary infarction and the antiplatelet therapies clopidogrel and ticagrelor. The databases used were PubMed, Google Scholar, Dynamed, and EBSCOhost. Eight articles were chosen based on subject matter related to the hypothesis, including cardioprotective effects, mortality benefits, platelet reactivity, angiographic effects, and electrocardiography changes. Results: Evidence from randomized clinical trials demonstrates that ticagrelor reduces infarct size, prevents remodeling, and reduces mortality rate after acute myocardial infarction to a greater extent than clopidogrel. However, some angiography studies show no difference between the two treatment regimes. Two articles show that ticagrelor is more effective in treating individuals with high platelet reactivity (HPR). In addition, there is some evidence of increased dyspnea and significant bleeding with ticagrelor. Discussion: Although there is growing evidence that ticagrelor is the better antiplatelet drug post-acute coronary infarction, more research needs to be done to determine the situations in which ticagrelor provides the optimal treatment regime in regards to cardioprotective effects, antiplatelet effects and an overall decrease in mortality. Conclusion: Ticagrelor was found to be superior to clopidogrel in relation to cardioprotective effects, mortality, and antiplatelet activity.

Resetting the neurohormonal balance in heart failure (HF): the relevance of the natriuretic peptide (NP) system to the clinical management of patients with HF

The natriuretic peptide (NP) system, which includes atrial natriuretic peptide, B-type natriuretic peptide, and C-type natriuretic peptide, has an important role in cardiovascular homeostasis, promoting a number of physiological effects including diuresis, vasodilation, and inhibition of the renin-angiotensin-aldosterone system. Heart failure (HF) is associated with defects in NP processing and synthesis, and there is a strong relationship between NP levels and disease state. NPs are useful biomarkers in HF, and their use in diagnosis and evaluation of prognosis is well established, particularly in patients with HF with reduced ejection fraction (HFrEF). There has also been interest in their use to guide disease management and therapeutic decision making. An understanding of NPs in HF has also resulted in interest in synthetic NPs for the treatment of HF and in treatments that target neprilysin, a protease that degrades NPs. A novel drug, the angiotensin receptor neprilysin inhibitor sacubitril/valsartan (LCZ696), which simultaneously inhibits neprilysin and blocks the angiotensin II type I receptor, was shown to have a favorable efficacy and safety profile in patients with HFrEF and has been approved for use in such patients in Europe and the USA. In light of the development of treatments that target neprilysin and of recent data in relation to synthetic NPs, it is timely to review the current understanding of the role of NPs in HF and their use in diagnosis, evaluating prognosis and guiding treatment, as well as their place in HF therapy.