Xu James, Lo Sidney, Mussap Christian J, French John K, Rajaratnam Rohan, Kadappu Krishna, Premawardhana Upul, Nguyen Phong, Juergens Craig P, Leung Dominic Y
Department of Cardiology, Liverpool Hospital, Sydney, Australia (J.X., S.L., C.J.M., J.K.P., R.P.).
South Western Sydney Clinical School, University of New South Wales, Sydney, Australia (J.X., S.L., C.J.M., J.K.F., R.R., K.K., U.P., P.N., C.P.J., D.Y.L.).
Circ Cardiovasc Interv. 2022 Apr;15(4):e011419. doi: 10.1161/CIRCINTERVENTIONS.121.011419. Epub 2022 Apr 4.
Coronary microvascular dysfunction after acute coronary syndrome is an important predictor of long-term prognosis. Data is lacking on the effects of oral P2Y-inhibitors on coronary microvascular function in non-ST-segment-elevation acute coronary syndrome. The aim of this study was to compare the acute effects of ticagrelor versus clopidogrel pretreatment on coronary microvascular function in non-ST-segment-elevation acute coronary syndrome patients.
Hospitalized non-ST-segment-elevation acute coronary syndrome patients were randomized (1:1) to ticagrelor or clopidogrel. The index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were obtained using an intracoronary pressure-temperature sensor-tipped wire.
In total, 128 patients were randomized between March 2018 and July 2020. Mean age 59.2±11.8 years, 84% were male, mean Global Registry of Acute Coronary Events score was 93.7±24.5. Intracoronary physiological measurements were obtained in 118 patients (60 ticagrelor, 58 clopidogrel). In the infarct-related artery, the ticagrelor group had lower baseline index of microcirculatory resistance (22.0 [13.0-34.9] versus 27.7 [19.3-29.8]; =0.02) and higher baseline resistive reserve ratio (3.0 [2.3-4.4] versus 2.4 [1.7-3.4]; =0.01) compared with the clopidogrel group. A total of 88 patients underwent percutaneous coronary intervention (PCI; 45 ticagrelor, 43 clopidogrel). The ticagrelor group had lower post-PCI index of microcirculatory resistance (22.0 [15.0-29.0] versus 27.0 [18.5-47.5]; =0.02) and higher post-PCI resistive reserve ratio (3.0 [1.8-3.8] versus 1.8 [1.5-3.4]; =0.006) compared with the clopidogrel group. The coronary flow reserve was not significantly different between the 2 groups at baseline or post-PCI. No between-group differences were seen in any of the indices in the non-infarct-related artery.
In non-ST-segment-elevation acute coronary syndrome patients, ticagrelor significantly improved coronary microvascular function before and after PCI compared with clopidogrel.
URL: https://www.anzctr.org.au; Unique identifier: ACTRN12618001610224.
急性冠状动脉综合征后冠状动脉微血管功能障碍是长期预后的重要预测指标。关于口服P2Y抑制剂对非ST段抬高型急性冠状动脉综合征患者冠状动脉微血管功能影响的数据尚缺乏。本研究的目的是比较替格瑞洛与氯吡格雷预处理对非ST段抬高型急性冠状动脉综合征患者冠状动脉微血管功能的急性影响。
将住院的非ST段抬高型急性冠状动脉综合征患者随机（1:1）分为替格瑞洛组或氯吡格雷组。使用冠状动脉内压力-温度传感器导丝获取微循环阻力指数、冠状动脉血流储备和阻力储备比。
2018年3月至2020年7月期间，共有128例患者被随机分组。平均年龄59.2±11.8岁，84%为男性，急性冠状动脉事件全球注册评分平均为93.7±24.5。118例患者（替格瑞洛组60例，氯吡格雷组58例）进行了冠状动脉内生理测量。在梗死相关动脉中，与氯吡格雷组相比，替格瑞洛组的基线微循环阻力指数较低（22.0[13.0-34.9]对27.7[19.3-29.8]；P=0.02），基线阻力储备比更高（3.0[2.3-4.4]对2.4[1.7-3.4]；P=0.01）。共有88例患者接受了经皮冠状动脉介入治疗（PCI；替格瑞洛组45例，氯吡格雷组43例）。与氯吡格雷组相比，替格瑞洛组PCI后微循环阻力指数较低（22.0[15.0-29.0]对27.0[18.5-47.5]；P=0.02），PCI后阻力储备比更高（3.0[1.8-3.8]对1.8[1.5-3.4]；P=0.006）。两组在基线或PCI后的冠状动脉血流储备无显著差异。在非梗死相关动脉的任何指标中，两组之间均未观察到差异。
在非ST段抬高型急性冠状动脉综合征患者中，与氯吡格雷相比，替格瑞洛在PCI前后显著改善了冠状动脉微血管功能。
