Antiplatelet Effect of Different Loading Doses of Ticagrelor in Patients With NoneST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: The APELOT Trial

作者：Liu, Hui-Liang^*; Wei, Yu-Jie; Ding, Peng; Zhang, Jiao; Li, Tian-Chang; Wang, Bing; Wang, Ming-Sheng; Li, Yun-Tian; Zhang, Jian-Jun; Ren, Yi-Hong; Tang, Qiang; Luo, Jian-Ping; Yang, Sheng-Li; Ma, Hong-Yu; Liu, Ying; Han, Wei; Li, Yi; Jin, Zhi-Geng; Jin, Li-Min

来源：Canadian Journal of Cardiology, 2017, 33(12): 1675-1682.

DOI：10.1016/j.cjca.2017.09.002

• TREATMENT PLATELET REACTIVITY
• CLOPIDOGREL
• CONSENSUS
• DEFINITION
• ANTAGONIST
• GUIDELINES
• OUTCOMES
• AZD6140
• SAFETY

Background: We hypothesized that a high ticagrelor loading dose (LD) may improve platelet inhibition in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). @@@ Methods: This interventional multicentre open-label trial randomized 278 patients with NSTE-ACS to a high (360 mg) or conventional (180 mg) ticagrelor LD. The primary outcome was the platelet reactivity index (PRI) 1 hour after administration of the LD. Secondary outcomes included PRI at 0.5 hour, 1 hour, 8 hours, and 24 hours; periprocedural myocardial infarction (PMI); major cardiac adverse events; and bleeding events. @@@ Results: Two hundred sixty-two patients completed the major end points. PRI was lower in the high-LD group than in the conventional-LD group at any time point (all, P < 0.05), including at 1 hour (12.2% vs 16.7%; P = 0.023). At 0.5 hour, the high-LD group showed a lower high-platelet reactivity rate (49.6% vs 60.2%; P = 0.013) and a higher low-platelet reactivity rate (24.8% vs 12.8%; P = 0.017) than did the conventional LD group. No significant differences in the bleeding rates were found between the 2 groups (14% vs 14.3%). Four cases of PMI and 1 death in each group, as well as 1 acute myocardial infarction in the conventional LD group, occurred. There was no stroke, target lesion revascularization, or target vessel revascularization. @@@ Conclusions: Doubling the ticagrelor LD achieved faster onset and greater platelet inhibition without an increase in adverse events in patients with NSTE-ACS undergoing PCI.

• 出版日期2017-12
• 单位北京大学; 北京市石景山医院; 中国人民解放军总医院; 中国人民解放军海军总医院