Iranian Heart Journal

Iranian Heart Journal

Effect of Ticagrelor Loading Time on the Outcomes of Primary Percutaneous Coronary Intervention

Document Type : Original Article

Authors
Ali R Tohamy
Hany Rayek Maher
Hosam R Hasan-Ali
Cardiovascular Medicine Department, Assiut University Heart Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Abstract
Background: Patients with acute coronary syndrome experience fewer major adverse cardiovascular events when receiving ticagrelor as opposed to clopidogrel. Additionally, patients with ST-segment elevation myocardial infarction (STEMI) receiving primary percutaneous coronary intervention (PPCI) show better coronary reperfusion and prognosis. This study compared the safety and effectiveness of ticagrelor doses administered early and late in patients with STEMI undergoing PPCI.
 
Methods: This prospective observational cohort study was conducted in a hospital with 350 patients diagnosed with recent STEMI and receiving PPCI. Patients were placed into 2 groups: prehospital (n = 179; loading dose > 60 min) and cath. lab (n = 171; loading dose < 60 min) before PPCI.
 
Results: Following a 6-month follow-up period, the Kaplan-Meier analysis revealed that 85.2% of the cath. lab group and 88.8% of the prehospital group were still clinically free and did not have any adverse events. There was no significant difference between the 2 groups (P = 0.357). The prehospital group had reduced thrombus load, greater post-PPCI ST-segment elevation resolution after 90 minutes, and considerably higher initial Thrombolysis in Myocardial Infarction (TIMI) flow grades II and III in the infarct-related artery than the cath. lab group. Both groups had comparable TIMI flow grades following PPCI.
 
Conclusions: Prehospital administration of ticagrelor with a median time of about 2 hours before PPCI was safe and helped improve angiographic pre-PCI coronary reperfusion in STEMI patients undergoing PPCI, without increasing the risk of bleeding events, but it did not significantly affect the final angiographic results. (Iranian Heart Journal 2026; 27(2): 17-26)
Keywords
early loading
late loading
ticagrelor
ST-segment elevation myocardial infarction
primary percutaneous coronary intervention
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Iranian Heart Journal
Volume 27, Issue 2
Spring 2026
Pages 17-26