Department of Internal Medicine, Konkuk University School of Medicine, Chungju, Korea.
Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Chungju, Korea.
Korean J Intern Med. 2021 Mar;36(2):352-361. doi: 10.3904/kjim.2019.293. Epub 2020 Jun 23.
BACKGROUND/AIMS: Coronary endothelial and microvascular function play important roles in cardiovascular disease. We aimed to evaluate the effect of ticagrelor on coronary artery function and tested the antiplatelet effect of low dose ticagrelor in East-Asian patients.
Sixty-one consecutive patients with non-significant coronary disease were included in the study. Initially, patients were randomized in 1:1:1 ratio to receive drugs: ticagrelor 90 mg twice a day (bid; n = 22), ticagrelor 45 mg bid (n = 19) or clopidogrel 75 mg once a day (qd; n = 20) and then divided into two groups (ticagrelor vs clopidogrel) for evaluation of coronary artery function, and three groups for evaluation of antiplatelet function. Endothelial dysfunction was measured by coronary flow reserve (CFR), and changes in the levels of asymmetric dimethylarginine (ADMA), cluster of differentiation (CD) 40 ligand, and P-selectin. Microvascular function was evaluated as index of microvascular resistance (IMR). Platelet reactivity was assessed by VerifyNow P2Y12 assay.
The levels of CFR, ADMA, and CD 40 ligand were not different between the two groups. However, P-selectin was lower in the ticagrelor group compared with clopidogrel group. IMR was significantly lower in the ticagrelor group compared with clopidogrel group (median, 15.0 [interquartile range, 12.0 to 21.0] vs. 47.5 [23.0 to 67.5], p = 0.014). There was significant difference in platelet inhibition among the three groups (ticagrelor 90 mg bid vs. ticagrelor 45 mg bid vs. clopidogrel 75 mg qd; 85.57 ± 47.63 vs. 120.33 ± 51.09 vs. 256.42 ± 55.10, p < 0.001).
It is hypothesized that ticagrelor might ameliorate the coronary microvascular function. When compared with clopidogrel, low dose ticagrelor exhibited satisfactory antiplatelet effect in the present study.
背景/目的：冠状动脉内皮和微血管功能在心血管疾病中起着重要作用。我们旨在评估替格瑞洛对冠状动脉功能的影响，并在东亚患者中测试低剂量替格瑞洛的抗血小板作用。
本研究纳入了 61 例连续的非显著冠状动脉疾病患者。最初，患者以 1:1:1 的比例随机接受药物治疗：替格瑞洛 90mg，每日两次（bid；n=22），替格瑞洛 45mg，bid（n=19）或氯吡格雷 75mg，每日一次（qd；n=20），然后分为两组（替格瑞洛与氯吡格雷）进行冠状动脉功能评估，并分为三组进行抗血小板功能评估。内皮功能障碍通过冠状动脉血流储备（CFR）进行测量，并检测不对称二甲基精氨酸（ADMA）、分化（CD）40 配体和 P-选择素的水平变化。微血管功能评估为微血管阻力（IMR）指数。血小板反应性通过 VerifyNow P2Y12 测定法进行评估。
两组间 CFR、ADMA 和 CD40 配体的水平无差异。然而，与氯吡格雷组相比，替格瑞洛组的 P-选择素水平较低。与氯吡格雷组相比，替格瑞洛组的 IMR 显著较低（中位数，15.0[四分位距，12.0 至 21.0] vs. 47.5[23.0 至 67.5]，p=0.014）。三组之间的血小板抑制有显著差异（替格瑞洛 90mg bid 组 vs. 替格瑞洛 45mg bid 组 vs. 氯吡格雷 75mg qd 组；85.57±47.63 vs. 120.33±51.09 vs. 256.42±55.10，p<0.001）。
推测替格瑞洛可能改善冠状动脉微血管功能。与氯吡格雷相比，本研究中低剂量替格瑞洛表现出令人满意的抗血小板作用。
