Design and Rationale for comParison Between ticagreLor and clopidogrEl on mIcrocirculation in Patients with Acute
Kyungil Park1,2, Young-Rak Cho3, Jong-Sung Park3
1Regional Cardiocerebrovascular Center, Division of Cardiology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea. cardiopark@gmail.com.
Insights
Ticagrelor may improve mortality in acute coronary syndrome (ACS) patients by enhancing coronary microcirculation. This study investigates ticagrelor
Area of Science:
- Cardiology
- Pharmacology
- Microcirculation Research
Background:
- Ticagrelor has shown mortality benefits over clopidogrel in acute coronary syndrome (ACS).
- The underlying mechanisms for ticagrelor's mortality reduction are not fully understood.
- Microvascular dysfunction is increasingly recognized in ACS pathophysiology.
Purpose of the Study:
- To evaluate the effect of chronic ticagrelor treatment on coronary microcirculation in ACS patients.
- To compare the impact of ticagrelor versus clopidogrel on microvascular resistance.
- To explore potential mechanisms beyond antiplatelet activity for ticagrelor's benefits.
Main Methods:
- A randomized controlled trial involving 120 ACS patients aged 20-85 years.
- Participants were assigned to receive either ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily.
- Coronary microvascular dysfunction was assessed using the index of microcirculatory resistance (IMR) at 6 months.
Main Results:
- The primary endpoint is the change in IMR at 6 months.
- Secondary analyses will explore differences in microvascular function between the two treatment groups.
- Patient demographics and baseline characteristics will be recorded.
Conclusions:
- This trial aims to elucidate whether ticagrelor improves coronary microcirculation more effectively than clopidogrel.
- Findings could provide insights into the mechanisms of ticagrelor-mediated mortality reduction in ACS.
- Results may inform clinical practice regarding the choice of P2Y12 inhibitors in ACS management.
Abstract:
It has been previously demonstrated that ticagrelor can reduce mortality compared to clopidogrel in acute coronary syndrome (ACS) patients. However, the mechanism for this mortality reduction remains uncertain. The objective of the present study is to assess the impact of chronic ticagrelor treatment on microvascular circulation. A total of 120 participants aged 20-85 years with clinical diagnosis of ACS will be randomized in a 1:1 fashion to the following two groups: ticagrelor 90 mg twice daily; clopidogrel 75 mg once daily. To evaluate the status of microcirculation, the primary end point is coronary microvascular dysfunction measured using an index of microcirculatory resistance (IMR) at 6 months after receiving the study agent. The purpose of this trial is to investigate whether ticagrelor, beyond its antiplatelet efficacy, could improve coronary microcirculation more effectively than clopidogrel for patients with ACS.
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