TY - JOUR
T1 - Platelet Inhibition, Endothelial Function, and Clinical Outcome in Patients Presenting With ST-Segment-Elevation Myocardial Infarction Randomized to Ticagrelor Versus Prasugrel Maintenance Therapy
T2 - Long-Term Follow-Up of the REDUCE-MVI Trial
AU - van der Hoeven, Nina W.
AU - Janssens, Gladys N.
AU - Everaars, Henk
AU - Nap, Alexander
AU - Lemkes, Jorrit S.
AU - de Waard, Guus A.
AU - van de Ven, Peter M.
AU - van Rossum, Albert C.
AU - Escaned, Javier
AU - Mejia-Renteria, Hernan
AU - Ten Cate, Tim J.F.
AU - Piek, Jan J.
AU - von Birgelen, Clemens
AU - Valgimigli, Marco
AU - Diletti, Roberto
AU - Riksen, Niels P.
AU - Van Mieghem, Nicolas M.
AU - Nijveldt, Robin
AU - van Leeuwen, Maarten A.H.
AU - van Royen, Niels
N1 - Copyright: This record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicine
PY - 2020/3/3
Y1 - 2020/3/3
N2 - Background Off-target properties of ticagrelor might reduce microvascular injury and improve clinical outcome in patients with ST-segment-elevation myocardial infarction. The REDUCE-MVI (Evaluation of Microvascular Injury in Revascularized Patients with ST-Segment-Elevation Myocardial Infarction Treated With Ticagrelor Versus Prasugrel) trial reported no benefit of ticagrelor regarding microvascular function at 1 month. We now present the follow-up data up to 1.5 years. Methods and Results We randomized 110 patients with ST-segment-elevation myocardial infarction to either ticagrelor 90 mg twice daily or prasugrel 10 mg once a day. Platelet inhibition and peripheral endothelial function measurements including calculation of the reactive hyperemia index and clinical follow-up were obtained up to 1.5 years. Major adverse clinical events and bleedings were scored. An intention to treat and a per-protocol analysis were performed. There were no between-group differences in platelet inhibition and endothelial function. At 1 year the reactive hyperemia index in the ticagrelor group was 0.66±0.26 versus 0.61±0.28 in the prasugrel group (P=0.31). Platelet inhibition was lower at 1 month versus 1 year in the total study population (61% [42%-81%] versus 83% [61%-95%]; P<0.001), and per-protocol platelet inhibition was higher in patients randomized to ticagrelor versus prasugrel at 1 year (91% [83%-97%] versus 82% [65%-92%]; P=0.002). There was an improvement in intention to treat endothelial function in patients randomized to ticagrelor (P=0.03) but not in patients randomized to prasugrel (P=0.88). Major adverse clinical events (10% versus 14%; P=0.54) and bleedings (47% versus 63%; P=0.10) were similar in the intention-to-treat analysis in both groups. Conclusions Platelet inhibition at 1 year was higher in the ticagrelor group, without an accompanying increase in bleedings. Endothelial function improved over time in ticagrelor patients, while it did not change in the prasugrel group. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique Identifier: NCT02422888.
AB - Background Off-target properties of ticagrelor might reduce microvascular injury and improve clinical outcome in patients with ST-segment-elevation myocardial infarction. The REDUCE-MVI (Evaluation of Microvascular Injury in Revascularized Patients with ST-Segment-Elevation Myocardial Infarction Treated With Ticagrelor Versus Prasugrel) trial reported no benefit of ticagrelor regarding microvascular function at 1 month. We now present the follow-up data up to 1.5 years. Methods and Results We randomized 110 patients with ST-segment-elevation myocardial infarction to either ticagrelor 90 mg twice daily or prasugrel 10 mg once a day. Platelet inhibition and peripheral endothelial function measurements including calculation of the reactive hyperemia index and clinical follow-up were obtained up to 1.5 years. Major adverse clinical events and bleedings were scored. An intention to treat and a per-protocol analysis were performed. There were no between-group differences in platelet inhibition and endothelial function. At 1 year the reactive hyperemia index in the ticagrelor group was 0.66±0.26 versus 0.61±0.28 in the prasugrel group (P=0.31). Platelet inhibition was lower at 1 month versus 1 year in the total study population (61% [42%-81%] versus 83% [61%-95%]; P<0.001), and per-protocol platelet inhibition was higher in patients randomized to ticagrelor versus prasugrel at 1 year (91% [83%-97%] versus 82% [65%-92%]; P=0.002). There was an improvement in intention to treat endothelial function in patients randomized to ticagrelor (P=0.03) but not in patients randomized to prasugrel (P=0.88). Major adverse clinical events (10% versus 14%; P=0.54) and bleedings (47% versus 63%; P=0.10) were similar in the intention-to-treat analysis in both groups. Conclusions Platelet inhibition at 1 year was higher in the ticagrelor group, without an accompanying increase in bleedings. Endothelial function improved over time in ticagrelor patients, while it did not change in the prasugrel group. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique Identifier: NCT02422888.
KW - ST‐segment‐elevation myocardial infarction
KW - endothelial function
KW - microvascular injury
KW - platelet inhibition
KW - prasugrel
KW - ticagrelor
UR - http://www.scopus.com/inward/record.url?scp=85081005743&partnerID=8YFLogxK
U2 - https://doi.org/10.1161/JAHA.119.014411
DO - https://doi.org/10.1161/JAHA.119.014411
M3 - Article
C2 - 32122216
SN - 2047-9980
VL - 9
SP - e014411
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 5
M1 - e014411
ER -