None listed
Conditions
Brief summary
Current treatment of heart attacks focuses on the large arteries of the heart where the blockages can be seen with injection of Xray dye (contrast). However, the small arteries of the heart are increasingly recognised to play a key role in affecting the outcome of patients after heart attacks. The function of the small arteries of the heart may be worsened by heart attacks and by balloons and stenting procedures to unblock the main arteries. It can also be worsened by life style factors like smoking and high cholesterol. The index of microcirculatory resistance (IMR) is a new measure and has been shown to be a highly precise and reliable method of assessing the function of the small arteries of the heart. However, it is unclear if this new measure applies to patients after non-ST elevation acute coronary syndromes (NSTE-ACS), which is the most common form of heart attacks presenting to hospitals. This study aims to use IMR to examine ways to improve function of the small arteries of the heart in patients after NSTE-ACS. We plan to primarily examine the effects of 2 different blood thinners (anti-platelet agents), clopidogrel and ticagrelor, on the IMR after NSTE-ACS. Both drugs are approved treatments for NSTE-ACS. All participants will receive standard medical care as determined by their treating doctors.
Interventions
Patients hospitalised for non-ST elevation acute coronary syndrome (a type of heart attack) and scheduled for coronary angiogram +/- percutaneous coronary intervention (procedure to open narrowed arteries) are eligible to participate. On admission, participants will be randomised to receive either clopidogrel (intervention) 300mg loading then 75mg daily, given orally, or ticagrelor (comparator) 180mg loading then 90mg twice-daily, given orally. Both are approved blood-thinning medications for he
Patients hospitalised for non-ST elevation acute coronary syndrome (a type of heart attack) and scheduled for coronary angiogram +/- percutaneous coronary intervention (procedure to open narrowed arteries) are eligible to participate. On admission, participants will be randomised to receive either clopidogrel (intervention) 300mg loading then 75mg daily, given orally, or ticagrelor (comparator) 180mg loading then 90mg twice-daily, given orally. Both are approved blood-thinning medications for heart attacks. The duration of these medications will be up to the discretion of the treating Cardiologist, and may range from 1 day up to 1 year or longer. During the angiogram procedure (which will occur no later than 72 hrs after admission), all patients will have their index of microcirculatory resistance (IMR) measured using a standard pressure wire. In patients requiring a clinically indicated repeat coronary angiogram, the IMR measurement will be also repeated at that time.
Sponsors
Liverpool Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients hospitalised for non-ST elevation acute coronary syndrome and scheduled for coronary angiogram +/- percutaneous coronary intervention
Exclusion criteria
1. Previous coronary bypass grafting 2. Prior myocardial infarction in target territory 3. Renal dysfunction with eGFR <30 mL/min/1.73m^2 4. Need for chronic oral anticoagulant therapy 5. Cardiogenic shock 6. Contraindications to adenosine 7. Pregnancy 8. Inability to give informed consent
Outcome results
None listed