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Ticagrelor Does Not Protect Against Endothelial Ischemia-Reperfusion Injury in Patients With Coronary Artery Disease
Journal of Cardiovascular Pharmacology and Therapeutics ( IF 2.5 ) Pub Date : 2020-10-23 , DOI: 10.1177/1074248420968693
Dinos Verouhis 1, 2 , Mattias Ekström 3 , Magnus Settergren 1, 2 , Peder Sörensson 1, 2 , John Pernow 1, 2 , Nawzad Saleh 1, 2
Affiliation  

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:

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。

更新日期:2020-10-29
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