Coronary Heart Disease
Conditions
Brief summary
Coronary microvascular dysfunction (CMD) is increasingly recognized as an important indicator for long-term prognosis in patients with acute myocardial infarction (AMI). The angiography-derived index of microcirculatory resistance (angio-IMR) is a novel guidewire-free measure for CMD in patients with AMI. Ticagrelor has recently been suggested to have additional benefits on coronary microcirculation beyond its antiplatelet effect. This study was designed to compare the protective effects of ticagrelor and clopidogrel on CMD and prognostic impact in patients with AMI, using the angio-IMR as a novel assessment tool.
Interventions
DRUGDual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel
Patients with acute myocardial infarction randomly received dual antiplatelet therapy with with aspirin 100mg daily and either ticagrelor 90mg twice daily or clopidogrel 75mg once daily for at least 9 months after PCI as needed.
Sponsors
Second Affiliated Hospital, School of Medicine, Zhejiang University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Inclusion criteria
* Patients who were diagnosed with AMI, including STEMI and NSTEMI, and underwent successful PCI and routine follow-up coronary angiography at the Second Affiliated Hospital of Zhejiang University School of Medicine between June 1, 2017 and May 31, 2020.
Exclusion criteria
* 1\) prior treatment with any P2Y12 inhibitor; * 2\) need for long-term oral anticoagulation therapy; * 3\) previous coronary artery bypass grafting (CABG); * 4\) chronic renal dysfunction with estimated glomerular filtration rate (eGFR) \<30 mL/ (min·1.73 m2) or on hemodialysis; * 5\) liver cirrhosis ≥Child-Pugh B class; * 6\) cancer; * 7\) adjustment of dual antiplatelet therapy (DAPT) during follow-up; * 8\) inadequate coronary angiographic images.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The improvement of angio-IMR | within 24 months post-PCI | Difference between Angio-IMR at follow-up coronary angiography and Angio-IMR after PCI |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Myocardial reinfarction | Within 24 months post-PCI | Another myocardial infarction with elevated myocardial enzymes and abnormal electrocardiograms |
| Target vessel revascularization | Within 24 months post-PCI | Repeat revascularization was performed because of ischemia in the target-vessel territory |
| Readmission for heart failure | Within 24 months post-PCI | Readmission for an acute exacerbation of chronic heart failure or acute heart failure |
| Cerebral hemorrhage | Within 24 months post-PCI | The occurrence of cerebral hemorrhage during the follow-up period was based on imaging CT and MRI |
| Other bleeding events | Within 24 months post-PCI | Bleeding events such as gingival bleeding, skin bleeding, and gastrointestinal bleeding and so on, occurred during the follow-up period |
| Non-target vessel revascularization | Within 24 months post-PCI | Repeat revascularization was performed because of ischemia in the non-target vessel territory |
Countries
China
Outcome results
None listed