Reducing Microvascular Dysfunction in Revascularized Patients with ST-Elevation Myocardial Infarction by Off-Target Properties of Ticagrelor versus Prasugrel. Rationale and Design of the REDUCE-MVI Study.
Microvascular injury is present in a large proportion of patients with ST-elevation myocardial infarction (STEMI) despite successful revascularization. Ticagrelor potentially mitigates this process by exerting additional adenosine-mediated effects. This study aims to determine whether ticagrelor is associated with a better microvascular function compared to prasugrel as maintenance therapy after STEMI. A total of 110 patients presenting with STEMI and additional intermediate stenosis in another coronary artery will be studied after successful percutaneous coronary intervention (PCI) of the infarct-related artery. Patients will be randomized to treatment with ticagrelor or prasugrel for 1 year. FFR-guided PCI of the non-infarct-related artery will be performed at 1 month. Microvascular function will be assessed by measurement of the index of microcirculatory resistance (IMR) in the infarct-related artery and non-infarct-related artery, immediately after primary PCI and after 1 month. The REDUCE-MVI study will establish whether ticagrelor as a maintenance therapy may improve microvascular function in patients after revascularized STEMI.
Department of Cardiology, Institute of Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. gl.janssens@vumc.nl.
Gladys N
GN
Janssens
Department of Cardiology, Institute of Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Maarten A H
MAH
van Leeuwen
Department of Cardiology, Institute of Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Nina W
NW
van der Hoeven
Department of Cardiology, Institute of Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Guus A
GA
de Waard
Department of Cardiology, Institute of Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Robin
R
Nijveldt
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Roberto
R
Diletti
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Felix
F
Zijlstra
Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente and Health Technology and Services Research, MIRA Institute, University of Twente Enschede, Enschede, The Netherlands.
Clemens
C
von Birgelen
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
Javier
J
Escaned
Department of Cardiology, Swiss Cardiovascular Center Bern, Bern, Switzerland.
Marco
M
Valgimigli
Department of Cardiology, Institute of Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Niels
N
van Royen
D000241:Adenosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006328:Cardiac Catheterization; D002985:Clinical Protocols; D053805:Fractional Flow Reserve, Myocardial / Q000187:drug effects*; D006801:Humans; D008833:Microcirculation / Q000187:drug effects*; D015428:Myocardial Reperfusion Injury / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D009426:Netherlands; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D012107:Research Design; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013030:Spain; D000077486:Ticagrelor; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
Adenosine; Microvascular injury; Prasugrel; ST-elevation myocardial infarction; Ticagrelor