Ticagrelor Treatment Associated With Increased Coronary Flow Reserve in Survivors of MI
An observational cross-sectional study of high-risk survivors of MI found higher CFR in ticagrelor participants suggesting pleiotropic effects of ticagrelor with benefits in combination with platelet inhibition.
It is already known that the pleiotropic action of ticagrelor, in addition to platelet inhibition, improves endothelial function in coronary artery disease patients. These positive effects are adenosine mediated.
Considering this background, the study investigated the association of ticagrelor therapy and coronary artery flow reserve in survivors of myocardial infarction (MI) patients.
This was an open substudy of PROFLOW. Using transthoracic Doppler echocardiography, researchers measured Coronary flow reserve (CFR) non-invasively in the left anterior descending artery. Coronary flow velocity was measured at rest and maximal flow after induction of hyperaemia by intravenous infusion of adenosine at 140 μg/kg/min.
Patients receiving ticagrelor were compared with those not receiving ticagrelor using simple and multiple linear regression models. In both groups, most patients, 97% in the ticagrelor and 94% in the non-ticagrelor group, were treated with aspirin.
Results
- The study included higher-risk individuals who had a history of Myocardial infarction.
- 81.8 % of participants were males, with a mean age of 68.
- Based on simple linear regression analysis, ticagrelor treatment was associated with increased CFR.
Conclusions
The study found the impact of ticagrelor on CFR to be pronounced in elderly patients, who are known to exhibit reduced CFR but attenuated in patients who had experienced another MI prior to the index MI.
The major limitation of this study was participants were not randomised and that there were differences in population background demographics.
The study further supports the growing body of data that describes the potential beneficial effects of ticagrelor on coronary microcirculation.
Swedish research council, the Swedish Heart-Lung Foundation, the Knut and Alice Wallenberg Foundation, and AstraZeneca funded the study.
Further reading:
https://www.heartlungcirc.org/article/S1443-9506(23)00147-6/fulltext?dgcid=raven_jbs_etoc_email
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