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Abstracts
9 Dual antiplatelet therapy to inhibit myocardial injury in patients with high-risk coronary artery plaque: a randomised controlled trial
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  1. Alastair J Moss1,
  2. Marc R Dweck1,
  3. Mhairi K Doris1,
  4. Jack PM Andrews1,
  5. Rong Bing1,
  6. Rachael O Forsythe1,
  7. Timothy R Cartlidge1,
  8. Tania A Pawade1,
  9. Marwa Daghem1,
  10. Jennifer B Raftis2,
  11. Michelle C Williams1,3,
  12. Edwin JR van Beek1,3,
  13. Laura Forsyth4,
  14. Steff C Lewis4,
  15. Robert Lee4,
  16. Anoop SV Shah1,5,
  17. Nicholas L Mills1,5,
  18. David E Newby1,3,
  19. Philip D Adamson1,6
  1. 1British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  2. 2Medical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
  3. 3Edinburgh Imaging, Queen’s Medical Research Institute University of Edinburgh, Edinburgh, UK
  4. 4Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
  5. 5Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
  6. 6Christchurch Heart Institute, University of Otago, Christchurch, New Zealand

Abstract

Introduction High-risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy. The aim of this study is to determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque using coronary 18F-fluoride positron emission tomography-computed tomography.

Methods In a randomised double-blind placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography-computed tomography and measurement of high-sensitivity cardiac troponin I and were randomised (1:1) to ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18F-fluoride uptake.

Results In total, 202 patients were randomized and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (n=120/191) there was no evidence that ticagrelor had an effect on plasma troponin concentrations at 30 days (ratio of geometric means for ticagrelor versus placebo, 1.11, [95% confidence interval 0.90 to 1.36], p=0.32). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18F-fluoride uptake (ratio of geometric means, 0.86, 95% confidence interval 0.63 to 1.17, p=0.33).

Conclusion Dual antiplatelet therapy with ticagrelor does not reduce plasma troponin concentrations in patients with coronary 18F-fluoride uptake. This suggests that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting.

https://doi.org/10.1136/heartjnl-2019-BSCI.9

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