Effect of a 180 mg ticagrelor loading dose on myocardial necrosis in patients undergoing elective percutaneous coronary intervention: A preliminary study

Abstract

(Cardiol J 2017; 24, 1: 15-24)

Study of Two Dose Regimens of Ticagrelor Compared With Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention for Stable Coronary Artery Disease

“…There were substantial numbers of patients with asymptomatic rises in troponin after PCI, but no evidence that ticagrelor was more effective than clopidogrel in attenuating troponin release, suggesting that the extent of myocardial injury induced by PCI is not usually sensitive to levels of platelet P2Y 12 inhibition in a low-risk population. This observation is consistent with a previously reported small elective PCI study, 31 but contrasts with another small study that demonstrated a reduced rate of MI with ticagrelor compared to clopidogrel. 32 Larger clinical outcomes studies are in progress that will provide more definitive data on this comparison (NCT02617290 and NCT02548611).…”

TIcagrelor in Rotational Atherectomy to Reduce TROPonin Enhancement: The TIRATROP Study, A Randomized Controlled Trial

“…Indeed, our results suggest that ticagrelor has no superior efficacy in the prevention of ischemic complications of RA, such as no reflow/slow flow. Few data are available about the effect of ticagrelor on post PCI troponin rise in stable CAD patients, and results were controversial until the ALPHEUS trial [ 7 , 8 , 9 ]. This trial did not show any difference between ticagrelor and clopidogrel in elective PCI on ischemic end points in a high-risk population for ischemic events despite relevant differences in pharmacodynamic effects among both arms.…”

“…The ALPHEUS (Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting) study failed to demonstrate ticagrelor superiority over clopidogrel in reducing periprocedural myocardial necrosis in stable coronary patients undergoing high-risk elective PCI. Data comparing ticagrelor with clopidogrel in stable coronary artery disease (CAD) patients are limited, and this drug has never been specifically evaluated in patients treated with rotational atherectomy (RA) [ 7 , 8 , 9 ]. RA facilitates PCI for de novo severely calcified or unexpandable lesions, which are increasingly prevalent in the elderly population.…”