Department of Nuclear Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea.
Regional Cardiocerebrovascular Center, Dong-A University Hospital, Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea.
Am Heart J. 2020 Apr;222:121-130. doi: 10.1016/j.ahj.2020.01.013. Epub 2020 Jan 27.
The PLEIO (comParison of ticagreLor and clopidogrEl on mIcrocirculation in patients with acute cOronary syndrome) study showed that 6 months of ticagrelor therapy significantly improved microvascular dysfunction in acute coronary syndrome (ACS) patients with stent implantation compared to clopidogrel. Improved microvascular function may affect myocardial blood flow (MBF). We compared the effects of ticagrelor and clopidogrel on MBF over a 6-month follow-up period among patients diagnosed with ACS treated with percutaneous coronary intervention (PCI).
In the PLEIO trial, 120 participants were randomized to receive ticagrelor 90 mg twice daily or clopidogrel 75 mg once daily after at least 6 months. 13 N-ammonia positron emission tomography (PET) imaging was performed in 94 patients to measure MBF at the 6-month follow-up visit.
On a per-patient level, MBF (1.88 ± 0.52 versus 1.67 ± 0.64 mL/min per gram, P = .01) was significantly higher with ticagrelor compared with clopidogrel in the hyperemic state, but not under resting state (0.75 ± 0.24 versus 0.75 ± 0.19 mL/min per gram, P = .84). On a culprit-vessel analysis, the resting MBF was similar (0.69 ± 0.20 versus 0.70 ± 0.21, P = .89) between the two groups. However, the hyperemic MBF and myocardial flow reserve in the ticagrelor group were significantly higher compared with clopidogrel (1.75 ± 0.46 versus 1.52 ± 0.59, P = .03 and 2.71 ± 0.89 versus 2.20 ± 0.81, P = .02, respectively). These differences were not observed in non-culprit vessels.
Maintenance treatment of ticagrelor increased the hyperemic MBF and myocardial flow reserve compared with clopidogrel.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02618733.
PLEIO（比较替格瑞洛和氯吡格雷对急性冠状动脉综合征患者微循环的影响）研究表明，与氯吡格雷相比，替格瑞洛治疗 6 个月可显著改善急性冠状动脉综合征（ACS）患者支架植入后的微血管功能障碍。改善的微血管功能可能会影响心肌血流（MBF）。我们比较了在接受经皮冠状动脉介入治疗（PCI）的 ACS 患者中，替格瑞洛和氯吡格雷在 6 个月随访期间对 MBF 的影响。
在 PLEIO 试验中，120 名患者被随机分配接受替格瑞洛 90mg 每日两次或氯吡格雷 75mg 每日一次治疗，至少 6 个月后。在 94 名患者中进行了 13N-氨正电子发射断层扫描（PET）成像，以在 6 个月的随访时测量 MBF。
在患者水平上，与氯吡格雷相比，替格瑞洛在充血状态下的 MBF（1.88±0.52 比 1.67±0.64mL/min/g，P=0.01）显著升高，但在休息状态下没有差异（0.75±0.24 比 0.75±0.19mL/min/g，P=0.84）。在罪犯血管分析中，两组之间的静息 MBF 相似（0.69±0.20 比 0.70±0.21，P=0.89）。然而，替格瑞洛组的充血性 MBF 和心肌血流储备明显高于氯吡格雷组（1.75±0.46 比 1.52±0.59，P=0.03 和 2.71±0.89 比 2.20±0.81，P=0.02，分别）。在非罪犯血管中未观察到这些差异。
与氯吡格雷相比，替格瑞洛的维持治疗增加了充血性 MBF 和心肌血流储备。
