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Ticagrelor to reduce myocardial injury in patients with high-risk coronary artery plaque

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Original languageEnglish
JournalJournal of the American College of Cardiology
Early online date14 Aug 2019
DOIs
Publication statusE-pub ahead of print - 14 Aug 2019

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 concentrationssuggesting 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 ¼ 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 ¼ 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 2019;-:-–-) © 2019 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/).

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