Ticagrelor to Reduce Myocardial Injury in Patients With High -Risk Coronary Artery Plaque
Ticagrelor to Reduce Myocardial Injury in Patients With High -Risk Coronary Artery Plaque
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DOI：
10.1016/j.jcmg.2019.05.023
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发表时间：
2020-07-01
影响因子：
14
通讯作者：
Adamson, Philip D.
中科院分区：
文献类型：
--
作者：
Moss, Alastair J.;Dweck, Marc R.;Adamson, Philip D.
目的本研究的目的是确定替卡格雷是否能降低冠心病和高危冠状动脉斑块患者的高敏感性肌钙蛋白I浓度。背景高危冠状动脉粥样硬化斑块与较高的血浆肌钙蛋白浓度相关，提示持续的心肌损伤可能是双重抗血小板治疗的靶点。方法采用随机、双盲、安慰剂对照试验，对多支冠状动脉病变患者行冠状动脉18F正电子发射计算机断层扫描和超敏心肌肌钙蛋白I测定，随机分为替卡格雷90 mg，每日2次，或与之匹配的安慰剂。主要终点是冠状动脉18F-氟摄取增加的患者在30天时肌钙蛋白I的浓度。结果总共有202名患者随机接受治疗，191名患者符合纳入初步分析的预先指定的标准。在冠状动脉18F-氟摄取增加的患者中(191人中的120人)，没有证据表明替卡格雷对30天的血浆肌钙蛋白浓度有影响(替卡格雷与安慰剂的几何均数比：1.11；95%可信区间：0.90~1.36；p=0.32)。1年以上，替卡格雷对冠状动脉18F-氟摄取增加的患者肌钙蛋白水平无影响(几何均数比：0.86；95%可信区间：0.63~1.17；p=0.33)。结论替卡格雷双重抗血小板治疗不能降低高危冠脉斑块患者的血浆肌钙蛋白浓度，提示亚临床斑块血栓形成在这种情况下不会导致持续的心肌损伤。(双重抗血小板疗法以减少心肌损伤[钻石]；NCT02110303)(J Am Coll心脏ol IMG 2020；13：1549-60)(C)2020作者。由爱思唯尔公司代表美国心脏病学会基金会出版。这是一篇基于CC by License(http://creativecommons.org/licenses/by/4.0/).的开放获取文章
OBJECTIVES The goal of this study was to determine whether ticagrelor reduces high -sensitivity troponin I concentrations in patients with established coronary artery disease and high -risk coronary plaque. BACKGROUND High -risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy. METHODS In a randomized, double-blind, placebo -controlled trial, patients with multivessel coronary artery disease underwent coronary 18 F - fluoride positron emission tomography/coronary computed tomography scanning and measurement of high -sensitivity cardiac troponin I. Patients were randomized (1:1) to receive ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18 F - fluoride uptake. RESULTS In total, 202 patients were randomized to treatment, and 191 met the pre -speci fied criteria for inclusion in the primary analysis. In patients with increased coronary 18 F - fluoride uptake (120 of 191), there was no evidence that ticagrelor had an effect on plasma troponin concentrations at 30 days (ratio of geometric means for ticagrelor vs. placebo: 1.11; 95% con fidence interval: 0.90 to 1.36; p = 0.32). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18 F - fluoride uptake (ratio of geometric means: 0.86; 95% con fidence interval: 0.63 to 1.17; p = 0.33). CONCLUSIONS Dual antiplatelet therapy with ticagrelor did not reduce plasma troponin concentrations in patients with high -risk coronary plaque, suggesting that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting. (Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND]; NCT02110303) (J Am Coll Cardiol Img 2020;13:1549 -60) (c) 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).