mersin univ saglık bilim derg Mersin Üniversitesi Sağlık Bilimleri Dergisi 1308-0830 Mersin University 10.26559/mersinsbd.1018841 Health Care Administration Sağlık Kurumları Yönetimi A comparison of the effects of ticagrelor and clopidogrel on development of no-reflow phenomenon after percutaneous coronary intervention in patients with acute myocardial infarction Akut miyokard infarktüslü hastalarda perkütan koroner girişim sonrası no-reflow fenomeni gelişimi üzerine klopidogrel ile tikagrelorun etkisinin karşılaştırılması https://orcid.org/0000-0003-4102-444X Yeşil Emrah MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI https://orcid.org/0000-0002-7226-4836 Uyar Hakan T.C. Sağlık Bakanlığı Mersin Şehir Eğitim ve Araştırma Hastanesi https://orcid.org/0000-0003-4349-9852 Örsçelik Özcan MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI https://orcid.org/0000-0002-0603-4370 Özkan Buğra MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI https://orcid.org/0000-0002-9417-7610 Çelik Ahmet MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI https://orcid.org/0000-0001-6607-8474 Özcan İsmail Türkay MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI https://orcid.org/0000-0002-9069-7854 Akkuş Mehmet Necdet MERSİN ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, KARDİYOLOJİ ANABİLİM DALI 08 31 2022 15 2 196 206 11 09 2021 02 02 2022 Copyright © 2008, Mersin Üniversitesi Sağlık Bilimleri Dergisi 2008 Mersin Üniversitesi Sağlık Bilimleri Dergisi

Aim: No-reflow phenomenon (NRP) is one of the significant factors affecting reperfusion. This study aimed to compare effects of preloading ticagrelor versus clopidogrel on development of NRP in patients with acute myocardial infarction (AMI), who underwent percutaneous coronary intervention (PCI). Method: Our retrospective single-center study included 200 patients, who underwent PCI due to AMI. Patients were classified as the patients preloaded with clopidogrel and ticagrelor based on the antiplatelet regimen administered before PCI. NRP criteria were determined according to the TIMI grade flow or ST-segment resolution after the procedure. The effect of ticagrelor and clopidogrel on NRP and the significance of the difference in specified parameters between patients with no-reflow and normal flow were evaluated. Results: There was no difference between patients with no-reflow and normal flow in terms of baseline characteristics. Number of patients with ST-elevation myocardial infarction was higher in patients preloaded with ticagrelor (p= 0.013). Age, aspartate aminotransferase (AST) and C-reactive protein (CRP) levels, CK-MB peaks, diabetes mellitus (DM) rate, mean length of stent, number of implanted stents, and number of patients with low left ventricular ejection fraction were significantly higher in patients with no-reflow. NRP development rate was significantly lower in patients preloaded with ticagrelor (19%, p= 0.001). This was independent of other independent variables including age, DM, AST, and CRP levels, number of implanted stents, and type of myocardial infarction (Odds value= 0.228, 95% confidence interval= 0.102-0.512, p<0.001). Conclusion: Ticagrelor was found to be superior to clopidogrel in preventing no-reflow.

Amaç: No-reflow fenomeni (NRF) miyokard reperfüzyonunu etkileyen en önemli faktörlerdendir. Bu çalışmada perkütan koroner girişim (PKG) uygulanan akut miyokard infarktüs(AMİ) lü hastalarda önyüklemede kullanılan tikagrelorun ve klopidogrele karşı NRF gelişimi üzerine olan etkisini araştırdık. Yöntem: Tek merkezli ve retrospektif çalışmamıza AMİ tanısıyla, PKG uygulanmış 200 hasta alındı. PKG öncesi verilen antiplatelet rejimine göre hastalar klopidogrel veya tikagrelor yüklenen hastalar olarak ayrıldı. NRF tanımlamada TIMI akım sınıflaması veya işlem sonrası ST segment rezolüsyonundan yararlanıldı. No-reflow gelişenler ve normal akım sağlananlar arasında belirtilen parametrelerdeki farkın anlamlılığı ve tikagrelorla klopidogrelin NRF üzerine olan etkisi değerlendirildi. Bulgular: No-reflow gelişenler ve normal akım sağlananlar arasında bazal karakteristik özellikler açısından fark yoktu. Tikagrelor yüklenen hasta grubunda ST elevasyonlu miyokard infaktüslü hasta sayısı daha yüksekti (p=0.013). No-reflow gelişen grupta yaş, aspartat aminotransferaz (AST), C-reaktif protein (CRP), pik CK-MB seviyeleri, diyabetes mellitus (DM) oranı, stent uzunluğu, stent sayısı, ve düşük ejeksiyon fraksiyonlu hasta sayısı anlamlı olarak yüksek bulundu. Tikagrelor yüklenen hastalarda NRF gelişme oranı anlamlı olarak düşüktü( %19 p=0.001). Bu düşüklük yaş, DM, AST ve CRP seviyeleri, yerleştirilmiş stent sayısı ve miyokard infarktüsü tipini de kapsayan diğer bağımsız değişkenlerden bağımsızdı (Odds değeri = 0.228, %95 güven aralığı = 0.102-0.512, p<0.001). Sonuç: Tikagrelorun no- reflow gelişimini önlemede klopidogrele üstün olduğu görüldü.

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