Effect of a Ticagrelor Loading Dose on Ventricular Remodeling in Elderly Patients with Acute Myocardial Infarction Undergoing Direct PCI

LIU Tong; LU Yinghui; LI Bei; ZHANG Wei

doi:10.12102/j.issn.1672-1349.2025.24.018

Abstract：Objective: To investigate the effect of a loading dose of ticagrelor on ventricular remodeling in elderly patients with acute myocardial infarction (AMI) undergoing direct percutaneous coronary intervention (PCI), based on the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling pathway. Methods: A total of 120 elderly AMI patients who underwent direct PCI at the General Hospital of Pingmei Shenma Medical Group from January 2021 to March 2022 were randomly divided into an observation group and a control group, each with 60 cases. The control group received clopidogrel during the perioperative period, while the observation group received a loading dose of ticagrelor. The two groups were compared in terms of coronary artery blood flow [Thrombolysis in Myocardial Infarction (TIMI) grade, Myocardial Blush Grade (MBG)], serum inflammatory factors [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6)], serum markers of left ventricular remodeling [matrix metalloproteinase-9 (MMP-9), brain natriuretic peptide (BNP), galectin-3 (Gal-3)], echocardiographic indicators of left ventricular remodeling [left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD)], expression levels of PI3K/AKT/mTOR signaling pathway-related proteins, and the incidence of major adverse cardiovascular events (MACE). Results: After PCI, the TIMI grade and MBG grade in the observation group were higher than those in the control group (P < 0.05). The serum levels of TNF-α, CRP, and IL-6 in the observation group were lower than those in the control group (P < 0.05). The decreases in serum MMP-9, BNP, and Gal-3 levels, as well as the decreases in LVEDD and LVESD and the increase in LVEF, along with the increases in PI3K, AKT, and mTOR protein expression, were greater in the observation group than in the control group (P < 0.05). There was no statistically significant difference in the incidence of MACE during hospitalization or after one-year follow-up between the two groups (P > 0.05). Conclusion: A loading dose of ticagrelor applied in elderly AMI patients undergoing direct PCI can effectively regulate coronary artery blood flow and improve ventricular remodeling without increasing the risk of MACE, and its mechanism is related to the PI3K/AKT/mTOR signaling pathway.