BACKGROUND: To examine whether a loading dose of ticagrelor on top of clopidogrel reduced postpercutaneous coronary intervention (PCI) myonecrosis. METHODS: Seventy seven coronary artery disease patients received a loading dose of 300 mg clopidogrel pre-PCI and were divided into three groups: group TT (n = 36): a loading dose of 180 mg ticagrelor pre-PCI, followed by ticagrelor 90 mg twice daily commencing one day post-PCI; group CT (n = 26): a maintenance dose of ticagrelor 90 mg twice daily; group CC (n = 15): clopidogrel 75 mg daily post- PCI. High sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) were measured pre-PCI and 0 h, 2 h or 24 h post-PCI. Platelet aggregation was measured in a separate cohort of 54 coronary artery disease patients (35 diabetic and 19 non-diabetic patients). RESULTS: There were no significant differences in hs-cTnT and CK-MB concentration among the three groups. In group TT, diabetic patients had significant higher Δhs-cTnT2h-0h than non-diabetic patients. In the second cohort, although baseline platelet aggregation was higher in diabetic than non-diabetic patients, platelet aggregation was comparable between diabetic and non-diabetic patients at 0 and 2 h post-PCI. CONCLUSIONS: This study indicates that a loading dose of ticagrelor does not significantly reduce post- PCI myonecrosis. Diabetes is associated with more post-PCI myonecrosis. A loading dose of ticagrelor effectively reduces platelet aggregation in diabetic patients.
BACKGROUND: To examine whether a loading dose of ticagrelor on top of clopidogrel reduced postpercutaneous coronary intervention (PCI) myonecrosis. METHODS: Seventy seven coronary artery diseasepatients received a loading dose of 300 mg clopidogrel pre-PCI and were divided into three groups: group TT (n = 36): a loading dose of 180 mg ticagrelor pre-PCI, followed by ticagrelor 90 mg twice daily commencing one day post-PCI; group CT (n = 26): a maintenance dose of ticagrelor 90 mg twice daily; group CC (n = 15): clopidogrel 75 mg daily post- PCI. High sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) were measured pre-PCI and 0 h, 2 h or 24 h post-PCI. Platelet aggregation was measured in a separate cohort of 54 coronary artery diseasepatients (35 diabetic and 19 non-diabeticpatients). RESULTS: There were no significant differences in hs-cTnT and CK-MB concentration among the three groups. In group TT, diabeticpatients had significant higher Δhs-cTnT2h-0h than non-diabeticpatients. In the second cohort, although baseline platelet aggregation was higher in diabetic than non-diabeticpatients, platelet aggregation was comparable between diabetic and non-diabeticpatients at 0 and 2 h post-PCI. CONCLUSIONS: This study indicates that a loading dose of ticagrelor does not significantly reduce post- PCI myonecrosis. Diabetes is associated with more post-PCI myonecrosis. A loading dose of ticagrelor effectively reduces platelet aggregation in diabeticpatients.
Authors: Rachel C Orme; William A E Parker; Mark R Thomas; Heather M Judge; Kathleen Baster; Wael Sumaya; Kenneth P Morgan; Hannah C McMellon; James D Richardson; Ever D Grech; Nigel M Wheeldon; Ian R Hall; Javaid Iqbal; David Barmby; Julian P Gunn; Robert F Storey Journal: Circulation Date: 2018-06-21 Impact factor: 29.690