Department of Cardiology, Patras University Hospital, Rion, Patras, Greece.
Circ Cardiovasc Interv. 2013 Jun;6(3):277-83. doi: 10.1161/CIRCINTERVENTIONS.113.000293. Epub 2013 Jun 4.
Prasugrel and ticagrelor provide a superior anti-ischemic action than clopidogrel, with some of ticagrelor's benefits possibly attributed to adenosine-mediated mechanisms. We aimed to compare the effect of maintenance dose of ticagrelor versus prasugrel on coronary blood flow velocity (CBFV) during increasing doses of intravenously administered adenosine.
In a prospective, single-center, single-blind, crossover study, 56 patients with non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention were randomized to receive either ticagrelor 90 mg BID or prasugrel 10 mg OD with a 15-day treatment period. At the end of each treatment period, CBFV by transthoracic Doppler echocardiography was assessed at baseline and under incremental doses (50 μg/kg per minute, 80 μg/kg per minute, 110 μg/kg per minute, and 140 μg/kg per minute) of adenosine infusion. Maximal CBFV area under the curve was higher for ticagrelor-treated than for prasugrel-treated patients, with a least squares mean difference of 7.16 (95% confidence interval, 2.61-11.7; P=0.003). Maximal CBFV/baseline CBFV ratio was higher with ticagrelor than prasugrel at 50, 80, and 110 μg/kg per minute but not at 140 μg/kg per minute adenosine infusion rate, with mean difference (95% confidence interval) of 0.17 (0.08-0.26; P<0.001), 0.21 (0.02-0.41; P=0.03), 0.24 (0.01-0.47; P=0.04), and 0.14 (-0.12 to 0.4; P=0.3), respectively.
In patients with non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention, ticagrelor augments CBFV to a greater extent than prasugrel when incremental doses of adenosine are administered. Although exploratory, these results may represent a pleiotropic action of ticagrelor, possibly contributing to its beneficial effects in such patients.
普拉格雷和替格瑞洛比氯吡格雷提供更好的抗缺血作用，替格瑞洛的一些益处可能归因于腺苷介导的机制。我们旨在比较维持剂量的替格瑞洛与普拉格雷对静脉给予腺苷时冠状动脉血流速度（CBFV）的影响。
在一项前瞻性、单中心、单盲、交叉研究中，56 名接受经皮冠状动脉介入治疗的非 ST 段抬高型急性冠状动脉综合征患者被随机分为替格瑞洛 90 mg BID 或普拉格雷 10 mg OD 组，治疗期为 15 天。在每个治疗期末，通过经胸多普勒超声心动图评估 CBFV，基础状态和递增剂量（50μg/kg/分钟、80μg/kg/分钟、110μg/kg/分钟和 140μg/kg/分钟）腺苷输注。替格瑞洛治疗组的最大 CBFV 曲线下面积高于普拉格雷治疗组，最小二乘均值差异为 7.16（95%置信区间，2.61-11.7；P=0.003）。替格瑞洛组在 50、80 和 110μg/kg/分钟时的 CBFV/基础 CBFV 比值高于普拉格雷组，但在 140μg/kg/分钟腺苷输注率时则不然，平均差值（95%置信区间）分别为 0.17（0.08-0.26；P<0.001）、0.21（0.02-0.41；P=0.03）、0.24（0.01-0.47；P=0.04）和 0.14（-0.12 至 0.4；P=0.3）。
在接受经皮冠状动脉介入治疗的非 ST 段抬高型急性冠状动脉综合征患者中，当给予递增剂量的腺苷时，替格瑞洛比普拉格雷更能增加 CBFV。虽然这是一项探索性研究，但这些结果可能代表替格瑞洛的一种多效性作用，可能有助于其在这类患者中的有益作用。
