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Effects of ticagrelor and prasugrel on coronary microcirculation in elective percutaneous coronary intervention

Fabio Mangiacapra1,2, Iginio Colaiori3, Giuseppe Di Gioia3

  • 1Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.

Heart (British Cardiac Society)
|June 14, 2023
PubMed

Insights

Ticagrelor improved coronary blood flow and microvascular function after percutaneous coronary intervention (PCI) compared to prasugrel. This suggests ticagrelor may reduce myocardial injury in stable coronary artery disease (CAD) patients undergoing PCI.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) management often involves percutaneous coronary intervention (PCI).
  • P2Y12 inhibitors like ticagrelor and prasugrel are crucial for preventing thrombotic events post-PCI.
  • Ticagrelor's potential effects on coronary microcirculation beyond platelet inhibition warrant investigation.

Purpose of the Study:

  • To compare the impact of ticagrelor versus prasugrel on coronary blood flow (Q) and microvascular resistance (R) in stable CAD patients undergoing elective PCI.
  • To assess the influence of these agents on myocardial injury markers post-PCI.

Main Methods:

  • A randomized trial involving 50 stable CAD patients undergoing PCI.
  • Patients received either ticagrelor (180 mg) or prasugrel (60 mg) loading dose at least 12 hours pre-PCI.
  • Coronary blood flow (Q) and microvascular resistance (R) were measured using continuous thermodilution pre- and post-PCI.
  • Platelet reactivity and troponin I levels were monitored.

Main Results:

  • The ticagrelor group exhibited significantly higher post-PCI coronary blood flow (Q) and lower microvascular resistance (R) compared to the prasugrel group.
  • Higher platelet reactivity correlated with reduced Q and increased R.
  • Periprocedural myocardial injury, indicated by troponin I levels, was significantly lower in the ticagrelor group.

Conclusions:

  • Pretreatment with ticagrelor, compared to prasugrel, enhances post-PCI coronary flow and microvascular function in stable CAD patients.
  • Ticagrelor appears to offer a protective effect, reducing myocardial injury associated with PCI.
  • These findings highlight ticagrelor's potential benefits in optimizing microvascular outcomes post-PCI.
Abstract

Keywords:
Coronary Artery DiseasePercutaneous Coronary Intervention

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