Fang Jiacheng, Zhang Yuxuan, Zheng Yiyue, Chen Delong, Yidilisi Abuduwufuer, Ji Rui, Xiang Jianping, Zhang Xinyi, Jiang Jun
Department of Cardiology, The Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, China.
State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China.
Cardiovasc Drugs Ther. 2024 Sep 2. doi: 10.1007/s10557-024-07619-4.
This research aimed to assess the impact of ticagrelor and clopidogrel on coronary microvascular dysfunction (CMD) and prognosis following acute myocardial infarction (AMI), using the angiography-derived index of microcirculatory resistance (angio-IMR) as a non-invasive assessment tool.
In this retrospective study, angio-IMR was performed to evaluate CMD before and after dual antiplatelet therapy (DAPT) with either ticagrelor (90 mg twice daily, n = 184) or clopidogrel (75 mg once daily, n = 72). The primary endpoint is the improvement of CMD evaluated by angio-IMR (delta angio-IMR) following DAPT. Secondary endpoints included myocardial reinfarction and readmission for heart failure during 2-year follow-up.
Compared with clopidogrel, ticagrelor exhibited a significantly higher delta angio-IMR [- 3.09 (5.14) versus - 1.99 (1.91), P = 0.008], indicating a superior improvement of CMD with ticagrelor treatment. Multivariate Cox regression indicated that ticagrelor treatment was related to a reduced risk of readmission for heart failure [8 (4.3) versus 9 (12.5), adjusted HR = 0.329; 95% CI = 0.116-0.934; P = 0.018] and myocardial reinfarction [7 (3.8) versus 8 (11.1), adjusted HR = 0.349; 95% CI = 0.125-0.975; P = 0.026]. Furthermore, ticagrelor treatment serves as an independent predictor of readmission for heart failure (HR = 0.322; 95% CI = 0.110-0.943; P = 0.039).
The results of this study indicate a potential association between ticagrelor treatment and improved CMD, as well as a reduced risk of cardiovascular events, including myocardial reinfarction and readmission for heart failure in AMI patients. Further randomized controlled trials are necessary to confirm the potential benefits of ticagrelor on CMD and cardiovascular prognosis. This clinical trial was registered in www.
gov (NCT05978726).
本研究旨在使用血管造影衍生的微循环阻力指数（血管造影-IMR）作为非侵入性评估工具，评估替格瑞洛和氯吡格雷对急性心肌梗死（AMI）后冠状动脉微血管功能障碍（CMD）和预后的影响。
在这项回顾性研究中，对接受替格瑞洛（每日两次，每次90毫克，n = 184）或氯吡格雷（每日一次，每次75毫克，n = 72）双联抗血小板治疗（DAPT）前后的患者进行血管造影-IMR检查，以评估CMD。主要终点是DAPT后通过血管造影-IMR评估的CMD改善情况（血管造影-IMR变化值）。次要终点包括2年随访期间的心肌再梗死和因心力衰竭再次入院。
与氯吡格雷相比，替格瑞洛的血管造影-IMR变化值显著更高[-3.09（5.14）对-1.99（1.91），P = 0.008]，表明替格瑞洛治疗能更显著地改善CMD。多因素Cox回归分析表明，替格瑞洛治疗与因心力衰竭再次入院风险降低相关[8例（4.3%）对9例（12.5%），调整后HR = 0.329；95%CI = 0.116 - 0.934；P = 0.018]以及心肌再梗死风险降低相关[7例（3.8%）对8例（11.1%），调整后HR = 0.349；95%CI = 0.125 - 0.975；P = 0.026]。此外，替格瑞洛治疗是因心力衰竭再次入院的独立预测因素（HR = 0.322；95%CI = 0.110 - 0.943；P = 0.039）。
本研究结果表明，替格瑞洛治疗与CMD改善以及心血管事件风险降低（包括AMI患者的心肌再梗死和因心力衰竭再次入院）之间可能存在关联。需要进一步的随机对照试验来证实替格瑞洛对CMD和心血管预后的潜在益处。本临床试验已在www.CLINICALTRIALS.gov（NCT05978726）注册。
