Maarten A H van Leeuwen1,2, Nina W van der Hoeven1, Gladys N Janssens1, Henk Everaars1, Alexander Nap1, Jorrit S Lemkes1, Guus A de Waard1, Peter M van de Ven3, Albert C van Rossum1, Tim J F Ten Cate4, Jan J Piek5, Clemens von Birgelen6, Javier Escaned7, Marco Valgimigli8, Roberto Diletti9, Niels P Riksen10, Nicolas M van Mieghem9, Robin Nijveldt1,4, Niels van Royen1,4. 1. Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L., N.W.v.d.H., G.N.J., H.E., A.N., J.S.L., G.A.d.W., A.C.v.R., R.N., N.v.R.). 2. Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands (M.A.H.v.L.). 3. Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands (P.M.v.d.V.). 4. Department of Cardiology (T.J.F.t.C., R.N., N.v.R.), Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (J.J.P.). 6. Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands (C.v.B.). 7. Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (J.E.). 8. Department of Cardiology, Bern University Hospital, Switzerland (M.V.). 9. Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands (R.D., N.M.v.M.). 10. Department of Internal Medicine (N.P.R.), Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
BACKGROUND: Despite successful restoration of epicardial vessel patency with primary percutaneous coronary intervention, coronary microvascular injury occurs in a large proportion of patients with ST-segment-elevation myocardial infarction, adversely affecting clinical and functional outcome. Ticagrelor has been reported to increase plasma adenosine levels, which might have a protective effect on the microcirculation. We investigated whether ticagrelor maintenance therapy after revascularized ST-segment-elevation myocardial infarction is associated with less coronary microvascular injury compared to prasugrel maintenance therapy. METHODS: A total of 110 patients with ST-segment-elevation myocardial infarction received a loading dose of ticagrelor and were randomized to maintenance therapy of ticagrelor (n=56) or prasugrel (n=54) after primary percutaneous coronary intervention. The primary outcome was coronary microvascular injury at 1 month, as determined with the index of microcirculatory resistance in the infarct-related artery. Cardiovascular magnetic resonance imaging was performed during the acute phase and at 1 month. RESULTS: The primary outcome of index of microcirculatory resistance was not superior in ticagrelor- or prasugrel-treated patients (ticagrelor, 21 [interquartile range, 15-39] U; prasugrel, 18 [interquartile range, 11-29] U; P=0.08). Recovery of microcirculatory resistance over time was not better in patients withticagrelor versus prasugrel (ticagrelor, -13.9 U; prasugrel, -13.5 U; P=0.96). Intramyocardial hemorrhage was observed less frequently in patients receiving ticagrelor (23% versus 43%; P=0.04). At 1 month, no difference in infarct size was observed (ticagrelor, 7.6 [interquartile range, 3.7-14.4] g, prasugrel 9.9 [interquartile range, 5.7-16.6] g; P=0.17). The occurrence of microvascular obstruction was not different in patients on ticagrelor (28%) or prasugrel (41%; P=0.35). Plasma adenosine concentrations were not different during the index procedure and during maintenance therapy with ticagrelor or prasugrel. CONCLUSIONS: In patients with ST-segment-elevation myocardial infarction, ticagrelor maintenance therapy was not superior to prasugrel in preventing coronary microvascular injury in the infarct-related territory as assessed by the index of microcirculatory resistance, and this resulted in a comparable infarct size at 1 month. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02422888.
RCT Entities:
BACKGROUND: Despite successful restoration of epicardial vessel patency with primary percutaneous coronary intervention, coronary microvascular injury occurs in a large proportion of patients with ST-segment-elevation myocardial infarction, adversely affecting clinical and functional outcome. Ticagrelor has been reported to increase plasma adenosine levels, which might have a protective effect on the microcirculation. We investigated whether ticagrelor maintenance therapy after revascularized ST-segment-elevation myocardial infarction is associated with less coronary microvascular injury compared to prasugrel maintenance therapy. METHODS: A total of 110 patients with ST-segment-elevation myocardial infarction received a loading dose of ticagrelor and were randomized to maintenance therapy of ticagrelor (n=56) or prasugrel (n=54) after primary percutaneous coronary intervention. The primary outcome was coronary microvascular injury at 1 month, as determined with the index of microcirculatory resistance in the infarct-related artery. Cardiovascular magnetic resonance imaging was performed during the acute phase and at 1 month. RESULTS: The primary outcome of index of microcirculatory resistance was not superior in ticagrelor- or prasugrel-treated patients (ticagrelor, 21 [interquartile range, 15-39] U; prasugrel, 18 [interquartile range, 11-29] U; P=0.08). Recovery of microcirculatory resistance over time was not better in patients with ticagrelor versus prasugrel (ticagrelor, -13.9 U; prasugrel, -13.5 U; P=0.96). Intramyocardial hemorrhage was observed less frequently in patients receiving ticagrelor (23% versus 43%; P=0.04). At 1 month, no difference in infarct size was observed (ticagrelor, 7.6 [interquartile range, 3.7-14.4] g, prasugrel 9.9 [interquartile range, 5.7-16.6] g; P=0.17). The occurrence of microvascular obstruction was not different in patients on ticagrelor (28%) or prasugrel (41%; P=0.35). Plasma adenosine concentrations were not different during the index procedure and during maintenance therapy with ticagrelor or prasugrel. CONCLUSIONS: In patients with ST-segment-elevation myocardial infarction, ticagrelor maintenance therapy was not superior to prasugrel in preventing coronary microvascular injury in the infarct-related territory as assessed by the index of microcirculatory resistance, and this resulted in a comparable infarct size at 1 month. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02422888.
Entities:
Keywords:
ST elevation myocardial infarction; microvessels; prasugrel hydrochloride; ticagrelor
Authors: Marie V Hjortbak; Kevin K W Olesen; Jacob M Seefeldt; Thomas R Lassen; Rebekka V Jensen; Alexander Perkins; Matthew Dodd; Tim Clayton; Derek Yellon; Derek J Hausenloy; Hans Erik Bøtker Journal: Basic Res Cardiol Date: 2021-05-26 Impact factor: 17.165
Authors: Nina W van der Hoeven; Gladys N Janssens; Henk Everaars; Alexander Nap; Jorrit S Lemkes; Guus A de Waard; Peter M van de Ven; Albert C van Rossum; Javier Escaned; Hernan Mejia-Renteria; Tim J F Ten Cate; Jan J Piek; Clemens von Birgelen; Marco Valgimigli; Roberto Diletti; Niels P Riksen; Nicolas M Van Mieghem; Robin Nijveldt; Maarten A H van Leeuwen; Niels van Royen Journal: J Am Heart Assoc Date: 2020-03-03 Impact factor: 5.501
Authors: Annette M Maznyczka; Peter J McCartney; Keith G Oldroyd; Mitchell Lindsay; Margaret McEntegart; Hany Eteiba; Paul Rocchiccioli; Richard Good; Aadil Shaukat; Keith Robertson; Vivek Kodoth; John P Greenwood; James M Cotton; Stuart Hood; Stuart Watkins; Peter W Macfarlane; Julie Kennedy; R Campbell Tait; Paul Welsh; Naveed Sattar; Damien Collison; Lynsey Gillespie; Alex McConnachie; Colin Berry Journal: J Am Heart Assoc Date: 2020-01-28 Impact factor: 5.501
Authors: Ahmet Demirkiran; Nina W van der Hoeven; Gladys N Janssens; Jorrit S Lemkes; Henk Everaars; Peter M van de Ven; Nikki van Pouderoijen; Yvonne J M van Cauteren; Maarten A H van Leeuwen; Alexander Nap; Paul F Teunissen; Luuk H G A Hopman; Sebastiaan C A M Bekkers; Martijn W Smulders; Niels van Royen; Albert C van Rossum; Lourens F H J Robbers; Robin Nijveldt Journal: Eur Heart J Cardiovasc Imaging Date: 2022-06-01 Impact factor: 9.130