Evaluation of Microvascular Injury in Revascularized Patients with ST Elevation Myocardial Infarction Treated with Ticagrelor versus Prasugrel: The REDUCE-MVI Trial.

van Leeuwen, Maarten A H; van der Hoeven, Nina W; Janssens, Gladys N; Everaars, Henk; Nap, Alexander; Lemkes, Jorrit S; de Waard, Guus A; van de Ven, Peter M; van Rossum, Albert C; Ten Cate, Tim J F; Piek, Jan J; von Birgelen, Clemens; Escaned, Javier; Valgimigli, Marco; Diletti, Roberto; Riksen, Niels P; Van Mieghem, Nicolas M; Nijveldt, Robin; van Royen, Niels (2019). Evaluation of Microvascular Injury in Revascularized Patients with ST Elevation Myocardial Infarction Treated with Ticagrelor versus Prasugrel: The REDUCE-MVI Trial. Circulation, 139(5), pp. 636-646. Lippincott Williams & Wilkins 10.1161/CIRCULATIONAHA.118.035931

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BACKGROUND Despite successful restoration of epicardial vessel patency with primary percutaneous coronary intervention (pPCI), coronary microvascular injury (MVI) occurs in a large proportion of STEMI patients, adversely affecting clinical and functional outcome. Ticagrelor has been reported to increase plasma adenosine levels, which might have a protective effect on the microcirculation. We investigated if ticagrelor maintenance therapy after revascularized STEMI is associated with less MVI compared to prasugrel maintenance therapy. METHODS A total of 110 STEMI patients received a loading dose of ticagrelor and were randomized to maintenance therapy of ticagrelor (n=56) or prasugrel (n=54) after pPCI. The primary outcome was MVI at 1 month, as determined with the index of microcirculatory resistance (IMR) in the infarct-related artery. Cardiovascular magnetic resonance imaging was performed during the acute phase and at one month. RESULTS The primary outcome of IMR was not superior in ticagrelor or prasugrel treated patients (ticagrelor 21 [15-39] U, prasugrel 18 [11-29] U, p=0.08). Recovery of microcirculatory resistance over time was not better in patients with ticagrelor versus prasugrel (ticagrelor -13.9 U vs. prasugrel -13.5 U, p=0.54). Intramyocardial hemorrhage was observed less frequently in patients with ticagrelor (23% vs. 43%, p=0.04). At one month no difference in infarct size was observed (ticagrelor 7.6 [IQR 3.7-14.4] g, prasugrel 9.9 [IQR 5.7-16.6] g, p=0.17). The occurrence of microvascular obstruction was not different in patients on ticagrelor (28%) or prasugrel (41%, p=0.35). Plasma adenosine concentrations were not different during the index procedure and during maintenance therapy with ticagrelor or prasugrel. CONCLUSIONS In patients with STEMI, ticagrelor maintenance therapy was not superior to prasugrel in preventing MVI in the infarct-related territory as assessed by IMR and this resulted in a comparable infarct size at one month. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov Unique identifier: NCT02422888.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0009-7322

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Amanda Valle

Date Deposited:

26 Feb 2019 16:17

Last Modified:

24 Oct 2019 08:24

Publisher DOI:

10.1161/CIRCULATIONAHA.118.035931

PubMed ID:

30586720

Uncontrolled Keywords:

STEMI microvascular injury ticagrelor

BORIS DOI:

10.7892/boris.124089

URI:

https://boris.unibe.ch/id/eprint/124089

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