AIMS In a randomized, parallel, blinded study, we investigate the impact of clopidogrel, prasugrel, or ticagrelor on peripheral endothelial function in patients undergoing stenting for an acute coronary syndrome. METHODS AND RESULTS The primary endpoint of the study was the change in endothelium-dependent flow-mediated dilation (FMD) following stenting. A total of 90 patients (age 62 ± 9 years, 81 males, 22 diabetics, 49 non-ST elevation myocardial infarctions) were enrolled. There were no significant differences among groups in any clinical parameter. Acutely before stenting, all three drugs improved FMD without differences between groups (P = 0.73). Stenting blunted FMD in the clopidogrel and ticagrelor group (both P < 0.01), but not in the prasugrel group. During follow-up, prasugrel was superior to clopidogrel [mean difference 2.13, 95% confidence interval (CI) 0.68-3.58; P = 0.0047] and ticagrelor (mean difference 1.57, 95% CI 0.31-2.83; P = 0.0155), but this difference was limited to patients who received the study therapy 2 h before stenting. Ticagrelor was not significantly superior to clopidogrel (mean difference 0.55, 95% CI -0.73 to 1.82; P = 0.39). No significant differences were seen among groups for low-flow-mediated dilation. Plasma interleukin (IL)-6 (P = 0.02 and P = 0.01, respectively) and platelet aggregation reactivity in response to adenosine diphosphate (P = 0.002 and P = 0.035) were lower in the prasugrel compared to clopidogrel and ticagrelor group. CONCLUSION As compared to ticagrelor and clopidogrel, therapy with prasugrel in patients undergoing stenting for an acute coronary syndrome is associated with improved endothelial function, stronger platelet inhibition, and reduced IL-6 levels, all of which may have prognostic implications. This effect was lost in patients who received the study medication immediately after stenting. EUDRACT-NO 2011-005305-73.

中文翻译：

---

氯吡格雷与普拉格雷与替格瑞洛对接受冠状动脉支架置入术的急性冠状动脉综合征患者内皮功能、炎症参数和血小板功能的影响：一项随机、盲法、平行研究

目的 在一项随机、平行、盲法研究中，我们调查了氯吡格雷、普拉格雷或替格瑞洛对接受支架置入治疗急性冠状动脉综合征的患者外周内皮功能的影响。方法和结果 研究的主要终点是支架植入后内皮依赖性血流介导扩张 (FMD) 的变化。共纳入 90 名患者（年龄 62 ± 9 岁，81 名男性，22 名糖尿病患者，49 名非 ST 段抬高心肌梗死）。在任何临床参数方面，各组之间没有显着差异。支架置入前急性期，所有三种药物均能改善 FMD，组间无差异（P = 0.73）。氯吡格雷和替格瑞洛组支架置入钝化口蹄疫（均 P < 0.01），但普拉格雷组没有。在随访期间，普拉格雷优于氯吡格雷 [平均差 2.13，95% 置信区间 (CI) 0.68-3.58；P = 0.0047] 和替格瑞洛（平均差 1.57，95% CI 0.31-2.83；P = 0.0155），但这种差异仅限于在支架置入前 2 小时接受研究治疗的患者。替格瑞洛没有显着优于氯吡格雷（平均差 0.55，95% CI -0.73 至 1.82；P = 0.39）。低流量介导的扩张组之间没有显着差异。与氯吡格雷和替格瑞洛组相比，普拉格雷的血浆白细胞介素 (IL)-6（分别为 P = 0.02 和 P = 0.01）和对二磷酸腺苷的血小板聚集反应性（P = 0.002 和 P = 0.035）较低。结 更强的血小板抑制作用和降低的 IL-6 水平，所有这些都可能具有预后意义。这种效果在支架植入后立即接受研究药物的患者中消失了。EUDRACT-NO 2011-005305-73。