Ticagrelor enhances the cardioprotective effects of ischemic preconditioning in stable patients undergoing percutaneous coronary intervention: the TAPER-S randomized study.

IF 5.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2024-05-04 DOI:10.1093/ehjcvp/pvad092

Domenico D'Amario, Mattia Galli, Attilio Restivo, Francesco Canonico, Rocco Vergallo, Stefano Migliaro, Carlo Trani, Francesco Burzotta, Cristina Aurigemma, Renzo Laborante, Enrico Romagnoli, Francesca Francese, Ilaria Ceccarelli, Josip A Borovac, Dominick J Angiolillo, Barbara Tavazzi, Antonio M Leone, Filippo Crea, Giuseppe Patti, Italo Porto

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Abstract

Background: Ticagrelor improves clinical outcomes in patients with acute coronary syndromes compared with clopidogrel. Ticagrelor also inhibits cell uptake of adenosine and has been associated with cardioprotective effects in animal models. We sought to investigate the potential cardioprotective effects of ticagrelor, as compared with clopidogrel, in stable patients undergoing percutaneous coronary intervention (PCI).

Methods and results: This was a Prospective Randomized Open Blinded End-points (PROBE) trial enrolling stable patients with coronary artery disease (CAD) requiring fractional flow reserve-guided PCI of intermediate epicardial coronary lesions. ST-segment elevation at intracoronary electrocardiogram (IC-ECG) during a two-step sequential coronary balloon inflations in the reference vessel during PCI was used as an indirect marker of cardioprotection induced by ischemic preconditioning (IPC). The primary endpoint of the study was the comparison of the delta (Δ) (difference) ST-segment elevation measured by IC-ECG during two-step sequential coronary balloon inflations.

Results: Fifty-three patients were randomized to either clopidogrel or ticagrelor. The study was stopped earlier because the primary endpoint was met at a pre-specified interim analysis. ΔST-segment elevation was significantly higher in ticagrelor as compared to clopidogrel arms (P < 0.0001). Ticagrelor was associated with lower angina score during coronary balloon inflations. There was no difference in coronary microvascular resistance between groups. Adenosine serum concentrations were increased in patients treated with ticagrelor as compared to those treated with clopidogrel.

Conclusions: Ticagrelor enhances the cardioprotective effects of IPC compared with clopidogrel in stable patients with CAD undergoing PCI. Further studies are warranted to fully elucidate the mechanisms through which ticagrelor may exert cardioprotective effects in humans.

Clinical trial registration: http://www.clinicaltrials.gov. Unique Identifier: NCT02701140.

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替格瑞洛增强经皮冠状动脉介入治疗稳定患者缺血预处理的心脏保护作用:TAPER-S随机研究

背景:与氯吡格雷相比，替格瑞洛可改善急性冠脉综合征患者的临床预后。替格瑞洛还能抑制腺苷的细胞摄取，并在动物模型中具有心脏保护作用。我们试图研究替格瑞洛与氯吡格雷在接受经皮冠状动脉介入治疗(PCI)的稳定患者中的潜在心脏保护作用。方法和结果:这是一项前瞻性随机开放盲法终点(PROBE)试验，纳入了需要分数血流储备(FFR)引导的中间心外膜冠状动脉病变的稳定冠状动脉疾病(CAD)患者。在PCI期间参考血管连续两步冠状动脉球囊膨胀期间，冠状动脉内(IC)心电图st段升高被用作缺血预处理诱导的心脏保护的间接标志。该研究的主要终点是比较两步顺序冠状动脉球囊膨胀期间冠状动脉内心电图测量的Δ (Δ)(差异)st段抬高。结果:53例患者随机分为氯吡格雷组和替格瑞组。研究提前终止，因为在预先指定的中期分析中达到了主要终点。与氯吡格雷组相比，替格瑞洛组的ΔST-segment升高明显高于氯吡格雷组(p结论:与氯吡格雷相比，替格瑞洛在接受PCI的稳定CAD患者中增强了缺血预处理的心脏保护作用。需要进一步的研究来充分阐明替格瑞洛在人体中发挥心脏保护作用的机制。临床试验注册:http://www.clinicaltrials.gov。唯一标识符:NCT02701140。

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来源期刊

European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

10.10

自引率

14.10%

发文量

期刊介绍： The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.