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Effects of ticagrelor and prasugrel on coronary microcirculation in elective percutaneous coronary intervention
  1. Fabio Mangiacapra1,2,
  2. Iginio Colaiori3,
  3. Giuseppe Di Gioia3,
  4. Mariano Pellicano3,
  5. Alex Heyse3,
  6. Luca Paolucci1,2,
  7. Aaron Peace4,
  8. Jozef Bartunek3,
  9. Bernard de Bruyne3,
  10. Emanuele Barbato5
  1. 1Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
  2. 2Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
  3. 3Cardiovasciular Research Center Aalst, OLV Hospital, Aalst, Belgium
  4. 4Altnagelvin Hospital, WHSCT, Derry, UK
  5. 5Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
  1. Correspondence to Dr Emanuele Barbato, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy; barba22{at}


Objective To compare the effects of ticagrelor and prasugrel on absolute coronary blood flow (Q) and microvascular resistance (R) in patients with stable coronary artery disease (CAD) treated with elective percutaneous coronary intervention (PCI) (NCT05643586). Besides being at least as effective as prasugrel in inhibiting platelet aggregation, ticagrelor has been shown to have additional properties potentially affecting coronary microcirculation.

Methods We randomly assigned 50 patients to ticagrelor (180 mg) or prasugrel (60 mg) at least 12 hours before intervention. Continuous thermodilution was used to measure Q and R before and after PCI. Platelet reactivity was measured before PCI. Troponin I was measured before, 8 and 24 hours after PCI.

Results At baseline, fractional flow reserve, Q and R were similar in two study groups. Patients in the ticagrelor group showed higher post-PCI Q (242±49 vs 205±53 mL/min, p=0.015) and lower R values (311 (263, 366) vs 362 (319, 382) mm Hg/L/min, p=0.032). Platelet reactivity showed a negative correlation with periprocedural variation of Q values (r=−0.582, p<0.001) and a positive correlation with periprocedural variation of R values (r=0.645, p<0.001). The periprocedural increase in high-sensitivity troponin I was significantly lower in the ticagrelor compared with the prasugrel group (5 (4, 9) ng/mL vs 14 (10, 24) ng/mL, p<0.001).

Conclusions In patients with stable CAD undergoing PCI, pretreatment with a loading dose of ticagrelor compared with prasugrel improves post-procedural coronary flow and microvascular function and seems to reduce the related myocardial injury.

  • Coronary Artery Disease
  • Percutaneous Coronary Intervention

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @fabmandoc, @BernardBruyne

  • Contributors FM and EB conceived the idea. FM, IC, GDG, MP, AH and AP joined the enrolment phase. FM and LP drafted the paper and performed statistical analysis. EB, JB and BdB critically revised the results and the manuscript. EB accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding GDG and MP have been supported by a research grant provided by the CardioPath PhD programme.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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