Sarpogrelate Based Triple Antiplatelet Therapy Improved Left Ventricular Systolic Function in Acute Myocardial Infarction: Retrospective Study

Abstract

PurposeThe purpose of this study was to assess the potential benefit of a 5-hydroxytryptamine receptor antagonist, sarpogrelate-based triple antiplatelet therapy (TAPT) in comparison with dual antiplatelet therapy (DAPT) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).Materials and Methods119 patients of STEMI were retrospectively assessed. All patients received aspirin and clopidogrel per standard of care. Among them, 53 patients received an additional loading dose of sarpogrelate and a maintenance dose for 6 months post-PCI (TAPT group), while others did not (DAPT group).ResultsThe rates of complete ST-segment resolution at 30 minutes post-PCI and post-procedural thrombolysis in myocardial infarction flow were not significantly different between the two groups (52.8% vs. 48.5%, p=0.200; 92.5% vs. 89.4%, p=0.080). In addition, no significant differences were observed between the two groups with regard to 30-day and 12-month clinical outcomes (cardiac death, myocardial infarction, stent thrombosis, target vessel revascularization, and severe bleeding). Meanwhile, improvement in left ventricular (LV) systolic function was observed in the TAPT group [ΔLV ejection fraction (LVEF)=17.1±9.4%, p<0.001; Δglobal longitudinal strain (GLS)=−9.4±4.2% , p<0.001] at 6 months, whereas it was not in the DAPT group (ΔLVEF= 8.8±6.5%, p=0.090; ΔGLS=−4.6±3.4%, p=0.106). In multivariate analyses, TAPT was an independent predictor for LV functional recovery (odds ratio, 2.61; 95% confidence interval, 1.16–5.87; p=0.003).ConclusionSarpogrelate-based TAPT improved LV systolic function at 6 months in STEMI patients undergoing primary PCI.

Changes in serum serotonin levels in patients with acute coronary syndrome and stable angina undergoing percutaneous coronary intervention

“…To overcome this problem, more potent P2Y12 receptor inhibitors, such as prasugrel or ticagrelor, might be necessary, particularly in patients with ACS, or a third agent could be added to inhibit serotonin-induced platelet activation. The present research group previously investigated the impact of triple antiplatelet therapy including aspirin, clopidogrel, and sarpogrelate (a selective 5HT2A receptor antagonist) in patients with acute STEMI undergoing PCI, and observed an improvement in left ventricular function at 6 months in the triple therapy group compared with the standard dual therapy group 37. Therefore, when prasugrel or ticagrelor are not indicated, adding a 5HT receptor antagonist to aspirin and clopidogrel might be a reasonable approach in patients undergoing PCI, whenever appropriate.…”

Blockade of 5‐HT2 receptors with sarpogrelate uncovers 5‐HT7 receptors inhibiting the tachycardic sympathetic drive in pithed rats

“…In summary, (a) the chronic blockade of sympatho‐excitatory 5‐HT 2 receptors reveals new sympatho‐inhibitory 5‐HT receptors that inhibit noradrenaline release from cardiac sympathetic nerves (current data); and (b) cardiac sympathetic hyperactivity plays a relevant pathophysiological role in the development of many cardiovascular pathologies such as hypertension, left ventricular hypertrophy, congestive heart failure and diabetes‐associated target organ damage . On this basis, the chronic blockade of 5‐HT 2 receptors with sarpogrelate may reasonably be a potential therapeutic option to manage the cardiac noradrenergic overdrive by unmasking other serotonergic receptors (as 5‐HT 7 receptors) that modulate the cardiac noradrenergic neurotransmission.…”

Impact of antiplatelet therapy on microvascular thrombosis during ST-elevation myocardial infarction

“…Left ventricular function did however improve in the triple therapy (treatment) group. No increase in bleeding was associated with sarpogrelate ( Choi et al, 2017 ).…”