Reducing microvascular injury in myocardial infarction.
Ticagrelor potentially mitigates the process of microvascular injury in ST-elevation myocardial infarction (STEMI) patients by exerting additional adenosine-mediated effects. The REDUCE-MVI study aims to determine whether ticagrelor is associated with a better microvascular function compared to prasugrel as maintenance therapy after STEMI. The study will be conducted internationally in five hospitals, the VU Medical Center, Amsterdam; Erasmus Medical Center, Rotterdam; Medisch Spectrum Twente, Enschede; Hospital Clínico San Carlos, Madrid and Academic Medical Centre, Amsterdam, and is supported by AstraZeneca.
Microvascular injury is present in a large proportion of patients with ST-elevation myocardial infarction (STEMI) despite successful revascularization. In the coming years, more insight into the biochemical mechanisms involved in STEMI may be expected, which may hopefully lead to the development of more specific drugs for microvascular preservation. Along this line, the REDUCE-MVI study is focused in more detail on current therapeutic options to retain microvascular integrity and function in patients with STEMI.
A total of 110 patients presenting with STEMI and additional intermediate stenosis in another coronary artery will be studied after successful percutaneous coronary intervention (PCI) of the infarct-related artery. Patients will be randomized to treatment with ticagrelor or prasugrel for 1 year. FFR-guided PCI of the non-infarct-related artery will be performed at 1 month. Microvascular function will be assessed by measurement of the index of microcirculatory resistance (IMR) in the infarct-related artery and non-infarct-related artery, immediately after primary PCI and after 1 month.
The REDUCE-MVI study will establish whether ticagrelor as a maintenance therapy may improve microvascular function in patients after revascularized STEMI.
More information about the clinical trial, see (1) and (2).
