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Randomized Trial Comparing the Effects of Ticagrelor Versus Clopidogrel on Myocardial Perfusion in Patients With Coronary Artery Disease.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2017 May 02; Vol. 6 (5). Date of Electronic Publication: 2017 May 02. - Publication Year :
- 2017
-
Abstract
- Background: Ticagrelor is a P2Y <subscript>12</subscript> receptor inhibitor used in acute coronary syndromes to reduce platelet activity and to decrease thrombus formation. Ticagrelor is associated with a reduction in mortality incremental to that observed with clopidogrel, potentially related to its non-antiplatelet effects. Evidence from animal models indicates that ticagrelor potentiates adenosine-induced myocardial blood flow (MBF) increases. We investigated MBF at rest and during adenosine-induced hyperemia in patients with stable coronary artery disease treated with ticagrelor versus clopidogrel.<br />Methods and Results: This randomized double-blinded crossover study included 22 patients who received therapeutic interventions of ticagrelor 90 mg orally twice a day for 10 days and clopidogrel 75 mg orally once a day for 10 days, with a washout period of at least 10 days between the treatments. Global and regional MBF and myocardial flow reserve were measured using rubidium 82 positron emission tomography/computed tomography at baseline and during intermediate- and high-dose adenosine. Global MBF was significantly greater with ticagrelor versus clopidogrel (1.28±0.55 versus 1.13±0.47 mL/min per gram, P =0.002) at intermediate-dose adenosine and not different at baseline (0.65±0.19 versus 0.60±0.15 mL/min per gram, P =0.084) and at high-dose adenosine (1.64±0.40 versus 1.61±0.19 mL/min per gram, P =0.53). In regions with impaired myocardial flow reserve (<2.5), MBF was greater with ticagrelor compared with clopidogrel during intermediate and high doses of adenosine ( P <0.0001), whereas the differences were not significant at baseline.<br />Conclusions: Ticagrelor potentiates global and regional adenosine-induced MBF increases in patients with stable coronary artery disease. This effect may contribute to the incremental mortality benefit compared with clopidogrel.<br />Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01894789.<br /> (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Subjects :
- Adenosine administration & dosage
Adenosine adverse effects
Administration, Oral
Aged
Clopidogrel
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease physiopathology
Coronary Vessels diagnostic imaging
Coronary Vessels physiopathology
Cross-Over Studies
Double-Blind Method
Drug Administration Schedule
Female
Humans
Male
Middle Aged
Myocardial Perfusion Imaging methods
Ontario
Platelet Aggregation Inhibitors adverse effects
Positron Emission Tomography Computed Tomography
Predictive Value of Tests
Radiopharmaceuticals administration & dosage
Rubidium Radioisotopes administration & dosage
Ticagrelor
Ticlopidine administration & dosage
Ticlopidine adverse effects
Time Factors
Treatment Outcome
Vasodilator Agents administration & dosage
Adenosine analogs & derivatives
Coronary Artery Disease drug therapy
Coronary Circulation drug effects
Coronary Vessels drug effects
Platelet Aggregation Inhibitors administration & dosage
Ticlopidine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 6
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 28465300
- Full Text :
- https://doi.org/10.1161/JAHA.117.005894