title: Comparison of Ticagrelor Versus Thienopyridine Loading Effect on Fractional Flow Reserve in Patients With Coronary Artery Disease.
abstract: Ticagrelor loading dose (LD) increases adenosine plasma levels, which might interfere with fractional flow reserve (FFR) assessment because the latter is based on adenosine-induced hyperemia. In a prospective study, consecutive patients who underwent coronary angiography with at least 1 de novo stenosis >50% and <90% in severity amenable to intervention underwent FFR assessment using intravenous adenosine 140 μg/kg/min for 3 minutes. Patients were subsequently randomized to either ticagrelor 180 mg (n = 38) or control thienopyridine (n = 38) (prasugrel 60 mg [n = 28] or clopidogrel 600 mg [n = 10]), followed by a second FFR assessment of the target lesion 2 hours after drug. Pre-drug, steady hyperemia FFR (sFFR, median, first to third quartiles) was 0.82 (0.75 to 0.88) and 0.81 (0.75 to 0.88), p = 0.9, whereas post-drug, 0.82 (0.72 to 0.87) and 0.79 (0.73 to 0.86), p = 0.5, in thienopyridine and ticagrelor-treated patients, respectively. The primary end point of percent relative change in sFFR between pre- and post-drug periods was greater in ticagrelor- than thienopyridine-treated patients, -1.24 (-5.54 to 0.0) versus -0.51 (-3.68 to 3.21), p = 0.03, respectively. Absolute change in sFFR between pre- and post-drug periods was marginally higher in ticagrelor- than thienopyridine-treated patients -0.01 (-0.04 to 0.0) versus -0.005 (-0.03 to 0.02), p = 0.048, respectively. Reclassification of treatment decision at the sFFR ≤ 0.80 cutoff post-drug occurred in 6 (15.8%) versus 5 (13.2%) of ticagrelor- and thienopyridine-treated patients, respectively. In conclusion, after ticagrelor LD, an absolute and relative reduction in sFFR compared with thienopyridine LD is observed. Administration of ticagrelor should be considered as a potential source, albeit minor, of FFR variability.
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece. Electronic address: dalex@med.upatras.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Periklis
authors.initials: P
authors.lastname: Davlouros
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Grigorios
authors.initials: G
authors.lastname: Tsigkas
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koutsogiannis
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Athena
authors.initials: A
authors.lastname: Hassapi
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Scortsanitis
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Pentara
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Chrysoula
authors.initials: C
authors.lastname: Vogiatzi
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Xanthopoulou
mesh_terms: D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D011725:Pyridines / Q000008:administration & dosage*; D000077486:Ticagrelor; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D011725:Pyridines; C446540:thienopyridine; D000077486:Ticagrelor; D000241:Adenosine