Effects of Ticagrelor and Clopidogrel on Coronary Microcirculation in Patients with Acute Myocardial Infarction.

Autor: Scanavini-Filho MA; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Berwanger O; Hospital Israelita Albert Einstein, 627 Albert Einstein Ave, São Paulo, SP, 05652-900, Brazil., Matthias W; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Aguiar MO; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Chiang HP; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Azevedo L; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Baracioli LM; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Lima FG; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Furtado RHM; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Dalcoquio TF; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Menezes FR; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Ferrari AG; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., de Luca F; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil., Giugliano RP; Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Ave, Boston, MA, 02215, USA., Goodman S; St. Michael's Hospital, University of Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada., Nicolau JC; Instituto do Coracao do Hospital das Clinicas da FMUSP, 44 Dr Enéas Carvalho de Aguiar Ave, São Paulo, SP, 05403-000, Brazil. jose.nicolau@incor.usp.br.; Rua Mato Grosso 306, CJ 713, São Paulo, SP, 01239-040, Brazil. jose.nicolau@incor.usp.br.
Jazyk: angličtina
Zdroj: Advances in therapy [Adv Ther] 2022 Apr; Vol. 39 (4), pp. 1832-1843. Date of Electronic Publication: 2022 Feb 26.
DOI: 10.1007/s12325-022-02061-0
Abstrakt: Introduction: Clopidogrel has been demonstrated to be effective in improving coronary microcirculation (CM) among patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolytics. Ticagrelor is a more potent adenosine diphosphate (ADP) receptor blocker proven to be superior to clopidogrel among patients with acute coronary syndromes. The present study aimed to compare the effects of ticagrelor and clopidogrel on CM in patients with STEMI treated with fibrinolytics.
Methods: The present study prospectively included 48 patients participating in the TREAT trial, which randomly assigned patients with STEMI undergoing fibrinolysis to ticagrelor versus clopidogrel. The primary endpoint of this study was the evaluation of the CM using the global myocardial perfusion score index (global MPSI) obtained by myocardial contrast echocardiography (MCE). Platelet aggregation to ADP was evaluated by Multiplate® and expressed as area under the curve (AUC).
Results: The global MPSI demonstrated no differences between the groups [mean 1.4 (1.2-1.5) in the ticagrelor group and 1.2 (1.2-1.5) in the clopidogrel group (p = 0.41)]. Platelet aggregability was lower in the ticagrelor group (18.1 ± 9.7 AUC), compared to the clopidogrel group (26.1 ± 12.5 AUC, p = 0.01).
Conclusion: We found no improvement in coronary microcirculation with ticagrelor compared to clopidogrel among patients with STEMI treated with fibrinolytics, despite the fact that platelet aggregation to ADP was lower with ticagrelor.
Clinical Trials Registration: NCT03104062.
(© 2022. The Author(s).)
Databáze: MEDLINE
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