Pretreatment with ticagrelor reduces troponin levels in stable CAD patients undergoing PCI
Italy: Pretreatment with a loading dose of ticagrelor (Brilinta) instead of prasugrel improves post-procedural microvascular function and coronary flow in patients with stable CAD (coronary artery disease) undergoing PCI, a small trial has shown. The findings of the trial were published in the BMJ journal Heart.
The research found that the periprocedural increase in high-sensitivity troponin I was significantly lower in the ticagrelor compared with the prasugrel group (5 (4, 9) ng/mL vs 14 (10, 24) ng/mL.
Emanuele Barbato, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy, and colleagues aimed to compare the effects of prasugrel (Effient) and ticagrelor (Brilinta) on absolute coronary blood flow (Q) and microvascular resistance (R) in patients with stable CAD treated with elective PCI (percutaneous coronary intervention). Ticagrelor has been shown to have additional properties potentially affecting coronary microcirculation besides being at least as effective as prasugrel in inhibiting platelet aggregation.
For this purpose, 50 patients were randomly assigned to ticagrelor (180 mg) or prasugrel (60 mg) at least 12 hours before the intervention. Continuous thermodilution was used for Q and R measures before and after PCI. Before PCI, platelet reactivity was measured. Troponin I was measured before, 8 and 24 hours after PCI.
The authors revealed the following findings:
- At baseline, fractional flow reserve, Q and R were similar in the two study groups.
- Patients in the ticagrelor group showed higher post-PCI Q (242±49 versus 205±53 mL/min) and lower R values (311 versus 362 mm Hg/L/min).
- Platelet reactivity showed a negative correlation with a periprocedural variation of Q values (r=−0.582) and a positive correlation with a periprocedural variation of R values (r=0.645).
- The periprocedural increase in high-sensitivity troponin I was significantly lower in the ticagrelor compared with the prasugrel group (5 ng/mL vs 14 ng/mL).
"Our findings suggest that pretreatment with a loading dose of ticagrelor compared with prasugrel improves post-procedural coronary flow and microvascular function and reduces the related myocardial injury in patients with stable CAD undergoing PCI," the researchers concluded.
Reference:
Mangiacapra F, Colaiori I, Di Gioia G, et alEffects of ticagrelor and prasugrel on coronary microcirculation in elective percutaneous coronary interventionHeart Published Online First: 14 June 2023. doi: 10.1136/heartjnl-2022-321868
