Mert AKER, Mehmet Ali FELEKOĞLU, İlkin GULİYEV, Murat TULMAÇ, Mehmet ERAT, Hamza SUNMAN, Sadık AÇIKEL, Tolga ÇİMEN, Engin ALGÜL, Muhammet DURAL

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Background/aim: Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that specifically increasesthe plasma level of adenosine, which is likely to cause atrial fibrillation (AF). Therefore, in this study we aimed to investigate theelectrocardiographic and echocardiographic predictors of AF development after P2Y12 receptor antagonists in ACS patients.Materials and methods: This cross-sectional study included 831 patients with ACS (486 [58.5%] with ST elevated myocardial infarction[STEMI] and 345 [41.5%] with non-ST elevated myocardial infarction [NSTEMI]). Patients were divided into ticagrelor (n = 410) andclopidogrel (n = 421) groups. P wave properties including P wave dispersion and atrial electromechanical conduction properties weremeasured as AF predictors with surface ECG and tissue Doppler imaging.Results: Baseline characteristics such as age, sex, heart rate, blood pressure, and laboratory parameters were almost the same in theticagrelor and clopidogrel groups. The statistical analysis showed no significant difference in P wave dispersion (PWD) betweenticagrelor and clopidogrel groups (40.98 ± 12 ms versus 40.06 ± 12 ms, P = 0.304). Subgroups analysis according to ACS types alsoshowed no significant difference in PWD (NSTEMI: 41.16 ± 13.8 ms versus 40.76 ± 13.55 ms, P = 0.799; STEMI: 40.9 ± 12.62 ms versus39.19 ± 11.18 ms, P = 0.132). In addition, we did not find significant difference in atrial electromechanical delay (EMD) with tissueDoppler imaging (interatrial EMD 24.11 ± 3.06 ms versus 24.46 ± 3.23 ms, P = 0.279).Conclusion: In conclusion, we did not find any difference in detailed electrocardiographic and echocardiographic parameters as AFpredictors between ticagrelor and clopidogrel groups in patients with ACS.

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