Platelet Inhibition, Endothelial Function, and Clinical Outcome in Patients Presenting With ST‐Segment–Elevation Myocardial Infarction Randomized to Ticagrelor Versus Prasugrel Maintenance Therapy: Long‐Term Follow‐Up of the REDUCE‐MVI Trial

Author:

van der Hoeven Nina W.1,Janssens Gladys N.1,Everaars Henk1,Nap Alexander1,Lemkes Jorrit S.1,de Waard Guus A.1,van de Ven Peter M.2,van Rossum Albert C.1,Escaned Javier3,Mejia‐Renteria Hernan3,ten Cate Tim J. F.4,Piek Jan J.5,von Birgelen Clemens6,Valgimigli Marco7,Diletti Roberto8,Riksen Niels P.19,Van Mieghem Nicolas M.8,Nijveldt Robin14,van Leeuwen Maarten A. H.110,van Royen Niels14

Affiliation:

1. Department of Cardiology Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands

2. Department of Epidemiology and Biostatistics Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam Cardiovascular Sciences Amsterdam the Netherlands

3. Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Madrid Spain

4. Department of Cardiology Radboud University Medical Center Nijmegen the Netherlands

5. Department of Cardiology Amsterdam UMC Academic Medical Center Amsterdam Cardiovascular Sciences Amsterdam the Netherlands

6. Department of Cardiology Medisch Spectrum Twente Enschede the Netherlands

7. Department of Cardiology Bern University Hospital Bern Switzerland

8. Department of Cardiology Erasmus MC Rotterdam the Netherlands

9. Department of Internal Medicine Radboud University Medical Center Nijmegen the Netherlands

10. Department of Cardiology Isala Heart Centre Zwolle the Netherlands

Abstract

Background Off‐target properties of ticagrelor might reduce microvascular injury and improve clinical outcome in patients with ST‐segment–elevation myocardial infarction. The REDUCEMVI (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: NCT 02422888.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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