Ticagrelor pretreatment and angiographic no-reflow in STEMI: a multicentre observational study.

Authors

Martino Pepe, Eduardo Urgesi, Rocco Tritto, Gianluigi Napoli, Salvatore Giordano, Angela Ivana Bruno, Pasquale Caldarola, Vincenzo Pestrichella, Paolo Colonna, Plinio Cirillo, Arturo Giordano, Giuseppe Biondi Zoccai, Sabino Iliceto, Marco Matteo Ciccone

Published in

Vascular pharmacology. Pages 107715. Oct 30, 2026. Epub Oct 30, 2026.

Abstract

We examined the association between ticagrelor pretreatment and angiographic no-reflow in ST-segment elevation myocardial infarction (STEMI), with in-hospital mortality as a secondary outcome and clinical phenotyping as an exploratory objective.
In a retrospective multicentre registry (2018-2021), 623 patients referred for percutaneous coronary intervention were compared by loading strategy: pretreatment at first medical contact or deferred before PCI. Cohort-wide inverse probability of treatment weighting (IPTW), using a clinical covariate-balancing propensity model and 50 imputations, estimated adjusted risk ratios (RRs). Outcome-blind latent class analysis preceded a treatment-weighted comparison of class-specific no-reflow risks.
No-reflow occurred in 28/464 pretreated patients versus 27/159 comparators (6.0% versus 17.0%); the crude RR was 0.36 (95% CI 0.22-0.58), and the IPTW-adjusted RR was 0.43 (95% CI 0.24-0.74; P = 0.003). Ten patients died (adjusted RR 0.46, 95% CI 0.13-1.67). Three classes comprised 328, 231 and 64 patients, but their pretreatment-standardised no-reflow risks did not establish prognostic separation.
Ticagrelor pretreatment was associated with lower angiographic no-reflow after propensity weighting. The adjusted mortality and exploratory class-risk findings did not reach statistical significance. Residual confounding and uncertain covariate timing limit causal interpretation, and prospective validation is required.

PMID:
42962950
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.