Ticagrelor Treatment is Associated With Increased Coronary Flow Reserve in Survivors of Myocardial Infarction
Description
Ticagrelor Treatment is Associated With Increased
Coronary Flow Reserve in Survivors of Myocardial Infarction
https://doi.org/10.1016/j.hlc.2023.03.010
Abstract
Background: The pleiotropic action of ticagrelor, with effects in addition to
platelet inhibition, has been shown to improve endothelial function in patients with coronary artery disease. These positive effects are
possibly adenosine mediated. This study investigated the association of
ticagrelor therapy and coronary artery flow reserve in survivors of myocardial
infarction (MI).
Methods: This was an exploratory, cross-sectional, open substudy
of PROFLOW. High-risk individuals with a history of MI were identified. Coronary flow reserve (CFR) was measured
non-invasively in the left anterior descending artery using transthoracic Doppler echocardiography. Coronary flow velocity was
measured at rest and at maximal flow after induction of hyperaemia by intravenous infusion of adenosine at 140
μg/kg/min. Patients receiving ticagrelor (n=75) were compared with those not
receiving ticagrelor (n=506), using simple and multiple linear regression models. Most patients in
both groups were treated with aspirin (97% in the ticagrelor
and 94% in the non-ticagrelor group). Adjustment for traditional risk factors
was conducted.
Results: The mean age at study inclusion was 68.5±6.8 years, and
most patients were male (81.8%). The simple linear regression analysis showed ticagrelor
treatment to be significantly associated with increased CFR: ticagrelor
2.95±0.76 (mean±SD), non-ticagrelor 2.70±0.77, (coefficient 0.25; 95% CI
0.063–0.438; p=0.009). This association was significant in two of the three
multiple linear regression models with increasing numbers of variables: Model 1
(0.28; 0.06–0.50; p=0.014), Model 2 (0.26; 0.03–0.48; p=0.025), and borderline
significant in Model 3 (0.21; –0.01 to 0.43; p=0.058).
Conclusions: Ticagrelor treatment was associated with
increased CFR in this high-risk population. Increased CFR may be a clinically
important therapeutic effect of ticagrelor in addition to platelet inhibition.
United States
