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Effect of a 180 mg ticagrelor loading dose on myocardial necrosis in patients undergoing elective percutaneous
QuanFu Xu, YingGang Sun, Yi Zhang
1Department of Cardiology, Xinhua Hospital A ffiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. msdoctor@126.com.
Insights
A loading dose of ticagrelor did not reduce myonecrosis after percutaneous coronary intervention (PCI). Diabetes increased post-PCI myonecrosis, but ticagrelor effectively reduced platelet aggregation in diabetic patients.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for coronary artery disease.
- Myonecrosis is a potential complication following PCI.
- Ticagrelor and clopidogrel are antiplatelet medications used to prevent adverse events after PCI.
Purpose of the Study:
- To investigate if a loading dose of ticagrelor, in addition to clopidogrel, reduces myonecrosis post-PCI.
- To assess the impact of diabetes on myonecrosis and platelet aggregation after PCI.
Main Methods:
- A study involving 77 coronary artery disease patients undergoing PCI.
- Patients received clopidogrel loading dose, then randomized to ticagrelor loading + maintenance, ticagrelor maintenance only, or clopidogrel maintenance.
- Cardiac biomarkers (hs-cTnT, CK-MB) and platelet aggregation were measured.
Main Results:
- No significant difference in myonecrosis markers (hs-cTnT, CK-MB) among the treatment groups.
- Diabetic patients showed higher myonecrosis in the ticagrelor loading group.
- Ticagrelor effectively reduced platelet aggregation in diabetic patients post-PCI.
Conclusions:
- A ticagrelor loading dose does not significantly decrease post-PCI myonecrosis.
- Diabetes is linked to increased myonecrosis following PCI.
- Ticagrelor loading dose demonstrates efficacy in reducing platelet aggregation in diabetic patients.
Background:
To examine whether a loading dose of ticagrelor on top of clopidogrel reduced postpercutaneous coronary intervention (PCI) myonecrosis.
Methods:
Seventy seven coronary artery disease patients received a loading dose of 300 mg clopidogrel pre-PCI and were divided into three groups: group TT (n = 36): a loading dose of 180 mg ticagrelor pre-PCI, followed by ticagrelor 90 mg twice daily commencing one day post-PCI; group CT (n = 26): a maintenance dose of ticagrelor 90 mg twice daily; group CC (n = 15): clopidogrel 75 mg daily post- PCI. High sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) were measured pre-PCI and 0 h, 2 h or 24 h post-PCI. Platelet aggregation was measured in a separate cohort of 54 coronary artery disease patients (35 diabetic and 19 non-diabetic patients).
Results:
There were no significant differences in hs-cTnT and CK-MB concentration among the three groups. In group TT, diabetic patients had significant higher Δhs-cTnT2h-0h than non-diabetic patients. In the second cohort, although baseline platelet aggregation was higher in diabetic than non-diabetic patients, platelet aggregation was comparable between diabetic and non-diabetic patients at 0 and 2 h post-PCI.
Conclusions:
This study indicates that a loading dose of ticagrelor does not significantly reduce post- PCI myonecrosis. Diabetes is associated with more post-PCI myonecrosis. A loading dose of ticagrelor effectively reduces platelet aggregation in diabetic patients.
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