Background:

Ticagrelor is a recommended P2Y₁₂ receptor inhibitor after acute coronary syndrome (ACS). Its superiority has been suggested to rely on pleiotropic effects beyond platelet inhibition. Experimental studies indicate that ticagrelor may protect from ischemia-reperfusion injury but no data are available from such studies on patients. This study aimed to determine if chronic ticagrelor treatment protects against endothelial ischemia-reperfusion injury in patients with a previous ACS.

Methods:

Patients with a previous ACS were studied with flow mediated dilatation of the left brachial artery to determine the degree of endothelial ischemia-reperfusion injury before and after discontinuation of ticagrelor treatment, which had been continuous since 1 year. Each patient underwent 3 identical examinations. The first examination (Visit A) was at the end of ticagrelor treatment and the following 2 (Visit B and C) were after cessation of this treatment with an interval of 2 to 4 weeks.

Results:

Ischemia and reperfusion induced significant impairment of endothelial function at all 3 occasions (absolute decline in flow mediated dilatation 3.0% ± 0.7 at Visit A (p < 0.001), 1.9% ± 0.9 at Visit B (p < 0.05) and 1.9% ± 0.4 at Visit C (p < 0.0001)). However, there was no difference in the degree of endothelial ischemia-reperfusion injury or baseline endothelial function between the visits.

Conclusion:

Chronic ticagrelor treatment in patients 1 year after an ACS does not protect against endothelial ischaemia-reperfusion injury. Nor is it associated with better basal endothelial function compared to after discontinuation of treatment.

中文翻译：

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替格瑞洛不能预防冠状动脉疾病患者的内皮缺血-再灌注损伤

背景：

替格瑞洛是急性冠脉综合征 (ACS) 后推荐的 P2Y ₁₂受体抑制剂。其优越性被认为依赖于血小板抑制之外的多效作用。实验研究表明，替格瑞洛可防止缺血再灌注损伤，但没有来自此类患者研究的数据。本研究旨在确定长期替格瑞洛治疗是否能防止既往 ACS 患者的内皮缺血再灌注损伤。

方法：

对既往 ACS 患者进行左肱动脉血流介导扩张的研究，以确定停止替格瑞洛治疗前后的内皮缺血-再灌注损伤程度，该治疗自 1 年以来一直持续。每位患者都接受了 3 次相同的检查。第一次检查（就诊 A）是在替格瑞洛治疗结束时进行的，接下来的 2 次（就诊 B 和 C）是在该治疗停止后间隔 2 至 4 周进行的。

结果：

缺血和再灌注在所有 3 种情况下均导致内皮功能显着受损（访问 A 时血流介导的扩张绝对下降 3.0% ± 0.7 (p < 0.001)，访问 B 时为 1.9% ± 0.9 (p < 0.05) 和 1.9% ± 0.4在访问 C (p < 0.0001))。然而，就诊之间的内皮缺血-再灌注损伤程度或基线内皮功能没有差异。

结论：

ACS 后 1 年对患者进行慢性替格瑞洛治疗并不能防止内皮缺血-再灌注损伤。与停止治疗后相比，它也与更好的基础内皮功能无关。