Comparison of the Effect of Clopidogrel and Ticagrelor on the Development of No-Reflow Phenomenon After Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

Background: No-reflow phenomenon (NRP) is one of the most important factors affecting myocardial reperfusion. Objective: In this study, we investigated the effect of ticagrelor and clopidogrel on the development of NRP in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: Our single-center, retrospective study included 200 patients with AMI who underwent PCI. The patients were divided into two groups according to the antiplatelet regimen given before PCI: clopidogrel- and ticagrelor-loaded groups. NRP was defined based on TIMI flow classification or post-procedural ST segment resolution. The difference in the parameters between patients with no-reflow and patients with normal flow as well as the effect of ticagrelor and clopidogrel on NRP were evaluated. Results: There was no difference in baseline characteristics between patients with no-reflow and patients with normal flow. The number of patients with ST-elevation myocardial infarction was higher in the ticagrelor-loaded group compared with the clopidogrel-loaded group (P = 0.013). Age, aspartate aminotransferase (AST), C-reactive protein (CRP), peak creatine kinase MB (CK-MB), diabetes mellitus (DM) rate, length of stent, number of stents, and number of patients with low ejection fraction were significantly higher in the no-reflow group compared with the normal flow group. The rate of NRP development was significantly lower in ticagrelor-loaded patients (19% P = 0.001), independent of other independent variables, including age, DM, AST, CRP level, number of stents implanted, and type of myocardial infarction (odds ratio = 0.228, 95% confidence interval = 0.102–0.512, P < 0.001). Conclusion: Ticagrelor is superior to clopidogrel in preventing the development of NRP.