P5506
Ticagrelor potentiates the cardioprotective effects of remote ischemic preconditioning

Extract

Background: Periprocedural myocardial necrosis is a common complication of percutaneous coronary intervention, often associated with worse prognosis. Remote ischemic preconditioning (RIPC) has been shown to reduce periprocedural myocardial injury through various pathways, including an adenosine-triggered pathway. Since several studies provide evidence that ticagrelor inhibits cellular uptake of adenosine, ticagrelor administration may potentiate the cardioprotective effects of RIPC.

Purpose: The aim of this randomized clinical trial was to test the hypothesis that treatment with ticagrelor will potentiate the effects of RIPC and, therefore, reduce periprocedural myocardial injury, as assessed by post-procedural troponin release.

Methods: This study was a randomized, assessor-blind, active comparator-controlled, clinical trial using a 2×2 factorial design, with 1:1 patient allocation to ticagrelor (TG) or clopidogrel (CL) and within each treatment a 1:1 allocation to RIPC or control (CTRL). Patients undergoing PCI for non-ST elevation acute coronary syndromes with stable or falling pre-procedural cardiac troponin I (cTnI) levels were considered eligible for inclusion. The primary endpoint of the study was the difference between post-procedural cTnI levels at 24 hours following PCI and pre-procedural cTnI, termed deltaTnI.