Evaluation of Microvascular Injury in Revascularized Patients With ST-Segment–Elevation Myocardial Infarction Treated With Ticagrelor Versus Prasugrel

• DOI: 10.1161/circulationaha.118.035931
• Publication Date: 2019-01-17T13:44:06Z
• Authors: Maarten A.H. van ...; Nina W. van der H...; Gladys N. Janssens; Henk Everaars; Alexander Nap; Jorrit S. Lemkes; Guus A. de Waard; Peter M. van de Ven; Albert C. van Rossum; Tim J.F. ten Cate; Jan J. Piek; Clemens von Birgelen; Javier Escaned; Marco Valgimigli; Roberto Diletti; Niels P. Riksen; Nicolas M. van Mi...; Robin Nijveldt; Niels van Royen
• Keywords: Interquartile range

Background: Despite successful restoration of epicardial vessel patency with primary percutaneous coronary intervention, microvascular injury occurs in a large proportion patients ST-segment–elevation myocardial infarction, adversely affecting clinical and functional outcome. Ticagrelor has been reported to increase plasma adenosine levels, which might have protective effect on the microcirculation. We investigated whether ticagrelor maintenance therapy after revascularized infarction is associated less compared prasugrel therapy. Methods: A total 110 received loading dose were randomized (n=56) or (n=54) intervention. The outcome was at 1 month, as determined index microcirculatory resistance infarct-related artery. Cardiovascular magnetic resonance imaging performed during acute phase month. Results: not superior ticagrelor- prasugrel-treated (ticagrelor, 21 [interquartile range, 15–39] U; prasugrel, 18 11–29] P =0.08). Recovery over time better versus −13.9 −13.5 =0.96). Intramyocardial hemorrhage observed frequently receiving (23% 43%; =0.04). At no difference infarct size 7.6 3.7–14.4] g, 9.9 5.7–16.6] g; =0.17). occurrence obstruction different (28%) (41%; =0.35). Plasma concentrations procedure prasugrel. Conclusions: In preventing territory assessed by resistance, this resulted comparable Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02422888.