First Results for Ticagrelor in Elective Coronary Angioplasty

This is one of the first studies on the use of ticagrelor in patients with stable coronary arteries who undergo elective angioplasty. Although its number of patients is low and its endpoints are soft, this work at least provides some support to what is already happening in daily clinical practice. Many patients admitted for a diagnostic angiography immediately followed by elective angioplasty (ad hoc) receive a ticagrelor dose in the lab.

Ticagrelor has shown an efficacy superior to that of clopidogrel, but only in patients admitted with acute coronary syndrome. In consequence, we had no data regarding its use in stable patients.

This study compared the pharmacodynamic effect of ticagrelor and clopidogrel in a stable population who already received aspirin. Patients were randomized 1:1:1 to either a standard clopidogrel regime vs. ticagrelor 60 mg every 12 hours vs. ticagrelor 90 mg every 12 hours (both ticagrelor regimes included a 180-mg loading dose). Cellular adenosine uptake was assessed before the procedure, immediately after, and at 1 month. Plasma adenosine concentration and platelet reactivity were measured at the same timepoints. High-sensitivity troponin T was measured before angioplasty and 18 and 24 hours after the procedure.

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The study included a total of 162 patients who underwent angioplasty (mean age: 65 years old; 21% had diabetes). There was no difference on in vitro adenosine uptake after the loading dose and at 1 month upon comparison of clopidogrel with both ticagrelor regimes.

Both maintenance doses of ticagrelor achieved more potent and consistent platelet inhibition than clopidogrel (p < 0.001), with lower platelet reactivity.

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There was a trend towards higher dyspnea with the 90-mg/12 h dose than the 60-mg/12 h dose (19% vs. 7.1%; p = 0.09).

Conclusion

The 60-mg and 90-mg ticagrelor maintenance doses had no detectable effect on cellular adenosine uptake at 1 month, but both achieved more potent platelet inhibition than clopidogrel. Such inhibition did not cause differences in the levels of high-sensitivity troponin T after the procedure.

Original title: Study of Two Dose Regimens of Ticagrelor Compared with Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention for Stable Coronary Artery Disease (STEEL-PCI).

Reference: Orme et al.  Circulation. 2018 Jun 21. Epub ahead of print.

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