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

doi:10.1016/j.jcmg.2019.05.023

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 journal › Article › peer-review

Abstract

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 language	English
Pages (from-to)	1549-1560
Journal	Journal of the American College of Cardiology
Volume	13
Issue number	7
Early online date	14 Aug 2019
DOIs	https://doi.org/10.1016/j.jcmg.2019.05.023
Publication status	Published - Jul 2020

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High-sensitivity Cardiac Troponin In The Prevention Of Cardiovascular Disease
Shah, A. (Principal Investigator), Mills, N. (Co-investigator) & Newby, D. (Co-investigator)
UK-based charities
1/08/19 → 31/07/20
Project: Research
Molecular THoracic imAging and bioiNformatics Approaches TO Sudden death (THANATOS) Study
Newby, D. (Principal Investigator), Bouhaidar, R. (Co-investigator) & Moss, A. (Co-investigator)
UK central government bodies/local authorities, health and hospital authorities
1/06/18 → 31/01/19
Project: Research
Combined positron emission tomography and magnetic resonance imaging of coronary atherothrombosis
Dweck, M. (Principal Investigator) & Newby, D. (Co-investigator)
UK-based charities
1/12/17 → 30/11/18
Project: Research

Edinburgh Imaging Facility
Grant, A. (Manager), van Beek, E. (Manager) & Semple, S. (Manager)
Deanery of Clinical Sciences
Facility/equipment: Facility

Michelle Williams
- Michelle.williamsed.acuk
- Deanery of Clinical Sciences - Personal Chair of Cardiovascular Imaging
- Centre for Cardiovascular Science
- Edinburgh Imaging
Person: Academic: Research Active , Academic: Research Active (Research Assistant)

Cite this

Moss, A. J., Dweck, M. R., Doris, M. K., Andrews, J. P. M., Bing, R., O. Forsythe, R., Cartlidge, T. R., Pawade, T. A., Daghem, M., Raftis, J. B., Williams, M. C., van Beek, E. J. R., Forsyth, L., Lewis, S. C., Lee, R. J., Shah, A. S. V., Mills, N. L., Newby, D. E., & Adamson, P. D. (2020). Ticagrelor to Reduce Myocardial Injury in Patients With High-Risk Coronary Artery Plaque. Journal of the American College of Cardiology, 13(7), 1549-1560. https://doi.org/10.1016/j.jcmg.2019.05.023

@article{7016ffdbc42a439fbc1e233df04c1218,

title = "Ticagrelor to Reduce Myocardial Injury in Patients With High-Risk Coronary Artery Plaque",

abstract = "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) {\textcopyright} 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).",

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

year = "2020",

month = jul,

doi = "10.1016/j.jcmg.2019.05.023",

language = "English",

volume = "13",

pages = "1549--1560",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "7",

}

Moss, AJ, Dweck, MR, Doris, MK, Andrews, JPM, Bing, R, O. Forsythe, R, Cartlidge, TR, Pawade, TA, Daghem, M, Raftis, JB, Williams, MC , van Beek, EJR , Forsyth, L , Lewis, SC, Lee, RJ, Shah, ASV, Mills, NL , Newby, DE & Adamson, PD 2020, 'Ticagrelor to Reduce Myocardial Injury in Patients With High-Risk Coronary Artery Plaque', Journal of the American College of Cardiology, vol. 13, no. 7, pp. 1549-1560. https://doi.org/10.1016/j.jcmg.2019.05.023

TY - JOUR

T1 - Ticagrelor to Reduce Myocardial Injury in Patients With High-Risk Coronary Artery Plaque

AU - Moss, Alastair J.

AU - Dweck, Marc R.

AU - Doris, Mhairi K.

AU - Andrews, Jack P.M.

AU - Bing, Rong

AU - O. Forsythe, Rachel

AU - Cartlidge, Timothy R.

AU - Pawade, Tania A.

AU - Daghem, Marwa

AU - Raftis, Jennifer B.

AU - Williams, Michelle C.

AU - van Beek, Edwin J.R.

AU - Forsyth, Laura

AU - Lewis, Steff C.

AU - Lee, Robert J.

AU - Shah, Anoop S.V.

AU - Mills, Nicholas L.

AU - Newby, David E.

AU - Adamson, Philip D.

PY - 2020/7

Y1 - 2020/7

N2 - 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).

AB - 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).

U2 - 10.1016/j.jcmg.2019.05.023

DO - 10.1016/j.jcmg.2019.05.023

M3 - Article

SN - 0735-1097

VL - 13

SP - 1549

EP - 1560

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 7

ER -

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

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Projects

High-sensitivity Cardiac Troponin In The Prevention Of Cardiovascular Disease

Molecular THoracic imAging and bioiNformatics Approaches TO Sudden death (THANATOS) Study

Combined positron emission tomography and magnetic resonance imaging of coronary atherothrombosis

Equipment

Edinburgh Imaging Facility

Profiles

Michelle Williams

Cite this