Long-Term Vascular Function in CTO Recanalization: A Randomized Clinical Trial of Ticagrelor vs. Clopidogrel
In: Cardiovascular Revascularization Medicine, Jg. 37 (2022-04-01), S. 61-67
Online
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Zugriff:
Background Coronary vascular function of a chronic coronary total occlusion (CTO) immediately after recanalization is known to be poor and to be partially improved by pre-treatment with loading dose of ticagrelor vs. clopidogrel . It is unknown if this vascular dysfunction is maintained at long-term follow-up and may be improved by 1-year dual antiplatelet therapy (DAPT). Methods The TIGER is a prospective, open-label, two parallel-group controlled clinical trial , which 1:1 randomized 50 CTO patients to pre-PCI loading dose and subsequent 1-year DAPT with ticagrelor vs. clopidogrel. Coronary blood flow (CBF) under stepwise adenosine infusion was assessed after drug loading dose and at follow-up and compared between the two drug groups, adjusting for time of follow-up. Results Out of 50 patients with index CBF evaluation, 38 (76%) patients underwent angiographic follow-up (23 and 15 at 1 and 3-year, respectively) and Doppler data was available in 35 (70%). A high CBF area under the curve (AUC), already observed after loading dose in ticagrelor vs. clopidogrel group (p = 0.027), was maintained at follow-up (AUC 34815.22 ± 24,206.06 vs. AUC 22712.47 ± 13,768.95; p = 0.071). Specifically, whereas high ticagrelor loading dose-related CBF was sustained at follow-up (p = 0.933), clopidogrel loading dose-related CBF increased at follow-up (p = 0.039). Conclusion The TIGER trial showed that DAPT with ticagrelor maintained a non-significantly higher CBF in a recanalized CTO as compared to clopidogrel, whose treated patients exhibit a lower CBF immediately after PCI with a significant increase at follow-up. The clinical value of such sustained high coronary flow should be evaluated in a larger group of patients. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02211066 (ClinicalTrials.gov number NCT02211066 ).
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Long-Term Vascular Function in CTO Recanalization: A Randomized Clinical Trial of Ticagrelor vs. Clopidogrel
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Autor/in / Beteiligte Person: | Moreno-Terribas, Gerardo ; Juan José Rodríguez-Arias ; Ortega-Paz, Luis ; Arévalos, Victor ; Romaguera, Rafael ; Oyarzabal, Loreto ; Sabaté, Manel ; Gómez-Lara, Josep ; Gil-Jimenez, Teresa ; Gomez-Hospital, Joan-Antoni ; Caballero-Borrego, Juan ; Teruel, Luis ; Brugaletta, Salvatore |
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Zeitschrift: | Cardiovascular Revascularization Medicine, Jg. 37 (2022-04-01), S. 61-67 |
Veröffentlichung: | Elsevier BV, 2022 |
Medientyp: | unknown |
ISSN: | 1553-8389 (print) |
DOI: | 10.1016/j.carrev.2021.06.129 |
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