Long-Term Vascular Function in CTO Recanalization: A Randomized Clinical Trial of Ticagrelor vs. Clopidogrel
| Autor: | Gerardo Moreno-Terribas, Juan José Rodríguez-Arias, Luis Ortega-Paz, Victor Arévalos, Rafael Romaguera, Loreto Oyarzabal, Manel Sabaté, Josep Gómez-Lara, Teresa Gil-Jimenez, Joan-Antoni Gomez-Hospital, Juan Caballero-Borrego, Luis Teruel, Salvatore Brugaletta |
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| Rok vydání: | 2022 |
| Předmět: |
Ticagrelor
medicine.medical_specialty Loading dose law.invention Percutaneous Coronary Intervention Randomized controlled trial law Internal medicine medicine Humans Prospective Studies Acute Coronary Syndrome business.industry Area under the curve General Medicine Blood flow Clopidogrel Clinical trial Treatment Outcome Conventional PCI Cardiology Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors circulatory and respiratory physiology medicine.drug |
| Zdroj: | Cardiovascular Revascularization Medicine. 37:61-67 |
| ISSN: | 1553-8389 |
| DOI: | 10.1016/j.carrev.2021.06.129 |
| Popis: | Background Coronary vascular function of a chronic coronary total occlusion (CTO) immediately after recanalization is known to be poor and to be partially improved by pre-treatment with loading dose of ticagrelor vs. clopidogrel . It is unknown if this vascular dysfunction is maintained at long-term follow-up and may be improved by 1-year dual antiplatelet therapy (DAPT). Methods The TIGER is a prospective, open-label, two parallel-group controlled clinical trial , which 1:1 randomized 50 CTO patients to pre-PCI loading dose and subsequent 1-year DAPT with ticagrelor vs. clopidogrel. Coronary blood flow (CBF) under stepwise adenosine infusion was assessed after drug loading dose and at follow-up and compared between the two drug groups, adjusting for time of follow-up. Results Out of 50 patients with index CBF evaluation, 38 (76%) patients underwent angiographic follow-up (23 and 15 at 1 and 3-year, respectively) and Doppler data was available in 35 (70%). A high CBF area under the curve (AUC), already observed after loading dose in ticagrelor vs. clopidogrel group (p = 0.027), was maintained at follow-up (AUC 34815.22 ± 24,206.06 vs. AUC 22712.47 ± 13,768.95; p = 0.071). Specifically, whereas high ticagrelor loading dose-related CBF was sustained at follow-up (p = 0.933), clopidogrel loading dose-related CBF increased at follow-up (p = 0.039). Conclusion The TIGER trial showed that DAPT with ticagrelor maintained a non-significantly higher CBF in a recanalized CTO as compared to clopidogrel, whose treated patients exhibit a lower CBF immediately after PCI with a significant increase at follow-up. The clinical value of such sustained high coronary flow should be evaluated in a larger group of patients. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02211066 (ClinicalTrials.gov number NCT02211066 ). |
| Databáze: | OpenAIRE |
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