Differential Effect of Ticagrelor Versus Prasugrel on Coronary Blood Flow Velocity in Patients With Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: An Exploratory Study

作者：Alexopoulos Dimitrios^*; Moulias Athanasios; Koutsogiannis Nikolaos; Xanthopoulou Ioanna; Kakkavas Apostolos; Mavronasiou Eleni; Davlouros Periklis; Hahalis George

来源：Circulation: Cardiovascular Interventions , 2013, 6(3): 277-283.

DOI：10.1161/CIRCINTERVENTIONS.113.000293

• acute coronary syndrome
• adenosine
• P2Y12 receptor
• prasugrel
• ticagrelor

Background Prasugrel and ticagrelor provide a superior anti-ischemic action than clopidogrel, with some of ticagrelor%26apos;s benefits possibly attributed to adenosine-mediated mechanisms. We aimed to compare the effect of maintenance dose of ticagrelor versus prasugrel on coronary blood flow velocity (CBFV) during increasing doses of intravenously administered adenosine. %26lt;br%26gt;Methods and Results In a prospective, single-center, single-blind, crossover study, 56 patients with non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention were randomized to receive either ticagrelor 90 mg BID or prasugrel 10 mg OD with a 15-day treatment period. At the end of each treatment period, CBFV by transthoracic Doppler echocardiography was assessed at baseline and under incremental doses (50 g/kg per minute, 80 g/kg per minute, 110 g/kg per minute, and 140 g/kg per minute) of adenosine infusion. Maximal CBFV area under the curve was higher for ticagrelor-treated than for prasugrel-treated patients, with a least squares mean difference of 7.16 (95% confidence interval, 2.61-11.7; P=0.003). Maximal CBFV/baseline CBFV ratio was higher with ticagrelor than prasugrel at 50, 80, and 110 g/kg per minute but not at 140 g/kg per minute adenosine infusion rate, with mean difference (95% confidence interval) of 0.17 (0.08-0.26; P%26lt;0.001), 0.21 (0.02-0.41; P=0.03), 0.24 (0.01-0.47; P=0.04), and 0.14 (-0.12 to 0.4; P=0.3), respectively. %26lt;br%26gt;Conclusions In patients with non-ST-elevation acute coronary syndrome undergoing percutaneous coronary intervention, ticagrelor augments CBFV to a greater extent than prasugrel when incremental doses of adenosine are administered. Although exploratory, these results may represent a pleiotropic action of ticagrelor, possibly contributing to its beneficial effects in such patients. %26lt;br%26gt;Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642966

• 出版日期2013-6