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Updated: Jan 31, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Evaluation of Microvascular Injury in Revascularized Patients With ST-Segment-Elevation Myocardial Infarction Treated
Maarten A H van Leeuwen1,2, Nina W van der Hoeven1, Gladys N Janssens1
1Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands (M.A.H.v.L., N.W.v.d.H., G.N.J., H.E., A.N., J.S.L., G.A.d.W., A.C.v.R., R.N., N.v.R.).
Insights
Ticagrelor maintenance therapy did not significantly reduce coronary microvascular injury after ST-elevation myocardial infarction compared to prasugrel. Both treatments resulted in similar infarct sizes and microvascular obstruction rates at one month.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Coronary microvascular injury is common after ST-segment-elevation myocardial infarction (STEMI) despite successful revascularization, impacting patient outcomes.
- Ticagrelor's potential to increase adenosine levels suggests a possible protective effect on microcirculation.
- This study aimed to compare ticagrelor and prasugrel for preventing microvascular injury in STEMI patients.
Purpose of the Study:
- To evaluate if ticagrelor maintenance therapy reduces coronary microvascular injury compared to prasugrel in STEMI patients post-primary percutaneous coronary intervention (PCI).
- To assess the impact of ticagrelor versus prasugrel on index of microcirculatory resistance (IMR) and infarct size.
Main Methods:
- A randomized trial involving 110 STEMI patients undergoing primary PCI.
- Patients received either ticagrelor or prasugrel maintenance therapy.
- Coronary microvascular injury was assessed using the index of microcirculatory resistance (IMR) and cardiovascular magnetic resonance imaging (CMR) at one month.
Main Results:
- No significant difference in IMR between ticagrelor and prasugrel groups (P=0.08).
- Ticagrelor was associated with less intramyocardial hemorrhage (23% vs. 43%, P=0.04).
- No significant differences in infarct size or microvascular obstruction were observed between the groups.
Conclusions:
- Ticagrelor maintenance therapy is not superior to prasugrel in preventing coronary microvascular injury in STEMI patients.
- Both agents result in comparable infarct sizes and microvascular obstruction at one month post-PCI.
Background:
Despite successful restoration of epicardial vessel patency with primary percutaneous coronary intervention, coronary microvascular injury occurs in a large proportion of patients with ST-segment-elevation myocardial infarction, 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 whether ticagrelor maintenance therapy after revascularized ST-segment-elevation myocardial infarction is associated with less coronary microvascular injury compared to prasugrel maintenance therapy.
Methods:
A total of 110 patients with ST-segment-elevation myocardial infarction received a loading dose of ticagrelor and were randomized to maintenance therapy of ticagrelor (n=56) or prasugrel (n=54) after primary percutaneous coronary intervention. The primary outcome was coronary microvascular injury at 1 month, as determined with the index of microcirculatory resistance in the infarct-related artery. Cardiovascular magnetic resonance imaging was performed during the acute phase and at 1 month.
Results:
The primary outcome of index of microcirculatory resistance was not superior in ticagrelor- or prasugrel-treated patients (ticagrelor, 21 [interquartile range, 15-39] U; prasugrel, 18 [interquartile range, 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; prasugrel, -13.5 U; P=0.96). Intramyocardial hemorrhage was observed less frequently in patients receiving ticagrelor (23% versus 43%; P=0.04). At 1 month, no difference in infarct size was observed (ticagrelor, 7.6 [interquartile range, 3.7-14.4] g, prasugrel 9.9 [interquartile range, 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 ST-segment-elevation myocardial infarction, ticagrelor maintenance therapy was not superior to prasugrel in preventing coronary microvascular injury in the infarct-related territory as assessed by the index of microcirculatory resistance, and this resulted in a comparable infarct size at 1 month.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov . Unique identifier: NCT02422888.
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