Abstract
BackgroundThe Platelet Inhibition and Patient Outcomes (PLATO, Eur J Prev Cardiol 22(6):734–42, 2015) trial shows that, in patients who have an acute coronary syndrome, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death, but the reason is still uncertain. Both inflammation and vascular endothelian cell dysfunction play important roles in the pathophysiology of atherosclerotic plaques, but whether ticagrelor has superior anti-inflammatory effect and can improve vascular endothelial cell function to a great extent is unknown.Methods/designPatients with STEMI who are scheduled to undergo emergency percutaneous coronary intervention (PCI) will be randomly assigned to receive a loading dose of ticagrelor 180 mg as the treatment group or clopidogrel 600 mg as the control group. After PCI, the treatment group will be treated with ticagrelor 90 mg twice daily while the control group will be treated with clopidogrel 75 mg once daily. The vascular endothelial function will be tested by circulating endothelial cells, and levels of inflammation will be tested by CD40 ligand (CD40L), high sensitivity C-reactive protein (hsCRP) and P-selectin. The estimated enrollment sample size will be 350 patients, including 175 in the treatment group and 175 in the control group.DiscussionThis study will compare the influence of ticagrelor and clopidogrel on inflammatory biomarkers and vascular endothelial function firstly for STEMI patients receiving emergency PCI and will provide evidence to identify whether ticagrelor inhibits inflammation and improves vascular endothelial cell function to a greater extent than clopidogrel or not.Trial registrationThis trial was registered with Clinicaltrials.gov (identifier: NCT02123004) on 20 April 2014.
Highlights
The Platelet Inhibition and Patient Outcomes (PLATO, Eur J Prev Cardiol 22(6):734–42, 2015) trial shows that, in patients who have an acute coronary syndrome, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death, but the reason is still uncertain
It is considered that plaque rupture caused by the joint action of inflammation and vascular endothelial cell dysfunction leads to Acute myocardial infarction (AMI), and the concentration of inflammatory markers is closely related to the degree of instability and progression of atherosclerotic plaque [6]
After percutaneous coronary intervention (PCI), the treatment group will be treated with ticagrelor 90 mg twice daily while the control group will be treated with clopidogrel 75 mg once daily
Summary
The Platelet Inhibition and Patient Outcomes (PLATO, Eur J Prev Cardiol 22(6):734–42, 2015) trial shows that, in patients who have an acute coronary syndrome, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death, but the reason is still uncertain. Both inflammation and vascular endothelian cell dysfunction play important roles in the pathophysiology of atherosclerotic plaques, but whether ticagrelor has superior anti-inflammatory effect and can improve vascular endothelial cell function to a great extent is unknown. Under the premise of recanalization of occlusions and revascularization, regulating inflammatory reactions of lesions is the key to improving the prognosis of patients with AMI
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