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Evaluación de la lesión microvascular en pacientes revascularizados con infarto de miocardio por elevación del
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.).
Circulation
|December 28, 2018
Resumen
El tratamiento de mantenimiento con ticagrelor no redujo significativamente la lesión microvascular coronaria después del infarto de miocardio por elevación de ST en comparación con prasugrel. Ambos tratamientos dieron como resultado tamaños de infarto y tasas de obstrucción microvascular similares a un mes.
Área de la Ciencia:
- Cardiología
- Farmacología
- Cardiología intervencionista
Sus antecedentes:
- La lesión microvascular coronaria es común después del infarto de miocardio por elevación del segmento ST (STEMI) a pesar de la revascularización exitosa, lo que afecta los resultados del paciente.
- El potencial de Ticagrelor para aumentar los niveles de adenosina sugiere un posible efecto protector sobre la microcirculación.
- Este estudio tuvo como objetivo comparar el ticagrelor y el prasugrel en la prevención de lesiones microvasculares en pacientes con ITST.
Objetivo del estudio:
- Evaluar si el tratamiento de mantenimiento con ticagrelor reduce la lesión microvascular coronaria en comparación con el prasugrel en pacientes con ITST después de la intervención coronaria percutánea primaria (ICP).
- Evaluar el impacto del ticagrelor frente al prasugrel en el índice de resistencia microcirculatoria (RMI) y el tamaño del infarto.
Principales métodos:
- Un ensayo aleatorizado en el que participaron 110 pacientes con STEMI sometidos a PCI primaria.
- Los pacientes recibieron tratamiento de mantenimiento con ticagrelor o prasugrel.
- La lesión microvascular coronaria se evaluó utilizando el índice de resistencia microcirculatoria (IMR) y la resonancia magnética cardiovascular (CMR) al mes.
Principales resultados:
- No hubo diferencias significativas en la RMI entre los grupos de ticagrelor y prasugrel (P=0,08).
- El ticagrelor se asoció con una menor hemorragia intramiocárdica (23% frente a 43%, P=0, 04).
- No se observaron diferencias significativas en el tamaño del infarto ni en la obstrucción microvascular entre los grupos.
Conclusiones:
- El tratamiento de mantenimiento con ticagrelor no es superior al prasugrel en la prevención de la lesión microvascular coronaria en pacientes con IMST.
- Ambos agentes dan como resultado tamaños comparables de infarto y obstrucción microvascular a un mes después de la ICP.
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