Abstract 20443: Differential Effect of Ticagrelor vs Thienopyridine Loading on Fractional Flow Reserve: Possible Implications for Clinical Practice
Background: Ticagrelor increases adenosine plasma levels and enhances coronary blood flow velocity during adenosine infusion, actions not possessed by thieonopyridines. It has been hypothesized that the degree of hyperemia obtained during fractional flow reserve (FFR) assessment may be altered in patients on ticagrelor.
Methods: In a prospective, single center, randomized study of parallel design, patients with at least one angiographically significant de novo stenosis (>50% and <90%) in at least one major epicardial coronary artery amenable to PCI, were allocated to loading dose (LD) with either ticagrelor 180mg (n=24) or control thienopyridine (n=24): prasugrel 60 mg (n=21) or clopidogrel 600 mg (n=3). FFR with adenosine 140 μg/kg/min infusion via a femoral vein was assessed prior to randomization (time 0) and 2 hours later. Aortic (Pa) and distal (Pd) intracoronary pressures were also recorded.
Results: We recruited 48 patients (mean age 63.5±9.8 years, 83.3% males, 25% diabetics, 58.3% with acute coronary syndrome >5 days), with mean lesion stenosis 73.9±11.6% (58.3% of lesions were localized in the LAD). FFR (measured at steady hyperemia) immediately prior to randomization (Hour 0) did not differ between ticagrelor and control group (0.79±0.1 vs 0.79±0.1, p=0.8). The primary endpoint of FFR % relative change from Hour 0 to Hour 2 was higher for ticagrelor vs control group: [median (first to third quartile) -2.47 (-5.10 to 0.00) vs -0.51 (-3.75 to 1.54), p=0.035]. Baseline-prior to adenosine infusion- pd/pa % relative change from Hour 0 to Hour 2 was significantly higher for ticagrelor compared to control group: [median (first to third quartile) -1.12 (-2.91 to 1.06) vs 0.00 (-0.75 to 3.32), p=0.015]. Reclassification of lesion severity (0.80 cut-off), in all cases favoring decision for intervention, occurred in 20.8% vs 12.5% in ticagrelor and control group, respectively (p=0.7).
Conclusions: Ticagrelor LD might affect FFR assessment at steady state hyperemia with possible clinical implications.
Author Disclosures: D. Alexopoulos: Honoraria; Modest; Astra Zeneca. I. Xanthopoulou: None. G. Tsigkas: None. N. Koutsogiannis: None. A. Hassapi: None. D. Ktenas: None. C. Schortsanitis: None. P. Davlouros: None.
- © 2014 by American Heart Association, Inc.