Ticagrelor to Reduce Myocardial Injury in Patients With High-Risk Coronary Artery Plaque

Alastair J. Moss, Marc R. Dweck, Mhairi K. Doris, Jack P.M. Andrews, Rong Bing, Rachel O. Forsythe, Timothy R. Cartlidge, Tania A. Pawade, Marwa Daghem, Jennifer B. Raftis, Michelle C. Williams, Edwin J.R. van Beek, Laura Forsyth, Steff C. Lewis, Robert J. Lee, Anoop S.V. Shah, Nicholas L. Mills, David E. Newby, Philip D. Adamson

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

OBJECTIVES: The goal of this study was to determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque.

BACKGROUND: 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.

METHODS: In a randomized, double-blind, placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography/coronary computed tomography scanning and measurement of high-sensitivity cardiac troponin I. Patients were randomized (1:1) to receive 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 to treatment, and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (120 of 191), there was no evidence that ticagrelor had an effect on plasma troponin concentrations at 30 days (ratio of geometric means for ticagrelor vs. 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).

CONCLUSIONS: Dual antiplatelet therapy with ticagrelor did not reduce plasma troponin concentrations in patients with high-risk coronary plaque, suggesting that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting. (Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND]; NCT02110303)
(J Am Coll Cardiol Img 2020;13:1549–60) © 2020 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0).
Original languageEnglish
Pages (from-to)1549-1560
JournalJournal of the American College of Cardiology
Volume13
Issue number7
Early online date14 Aug 2019
DOIs
Publication statusPublished - Jul 2020

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