Effects of ticagrelor on cardiorespiratory fitness in patients after percutaneous coronary intervention

Abstract

Objective: To investigate the effects of ticagrelor on cardiorespiratory fitness in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods: A total of 1 073 patients, who were diagnosed as coronary heart disease and underwent cardiopulmonary exercise testing (CPET) within 1 year after PCI, were enrolled from September 2017 to September 2019 in Peking University Third Hospital, including 309 patients in ticagrelor group and 764 patients in clopidogrel group. Clinical information, blood test results, echocardiographic parameters, cardiorespiratory fitness related parameters (including peak oxygen uptake (VO(2)), anaerobic threshold VO(2), peak oxygen pulse (VO(2)/HR) and carbon dioxide ventilation equivalent (VE/VCO(2)) slope), coronary lesions and intervention information were obtained. Cardiopulmonary fitness related indexes were compared between the two groups, and the correlation between ticagrelor use and cardiopulmonary fitness related indexes was analyzed by multivariate logistic regression. Patients who underwent CPET within 1 month after PCI were included in the subgroup analysis. Results: In ticagrelor group, the age was (60.3±10.3) years, and 253(81.9%) cases were male. The age of clopidogrel group was (60.6±10.0) years, and there were 608(79.6%) males. No significant differences were observed in peak VO(2), anaerobic threshold VO(2), and peak VO(2)/HR between the two groups (all P>0.05), but the VE/VCO(2) slope was significantly higher in the ticagrelor group than in the clopidogrel group (30.075 (27.207, 33.603) vs. 28.853 (25.970, 32.336), P<0.001). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with the ticagrelor use (all P>0.05), while the VE/VCO(2) slope was independently correlated with ticagrelor use (OR=1.098, 95%CI 1.032-1.168, P=0.003). Subgroup analysis of patients who underwent CPET within 1 month after PCI also indicated that no significant difference were observed in peak VO(2), anaerobic threshold VO(2), peak VO(2)/HR and VE/VCO(2) slope between the two groups (all P>0.05). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with ticagrelor use (all P>0.05), while the VE/VCO(2) slope was significantly correlated with ticagrelor use (OR=1.132, 95%CI 1.030-1.244, P=0.010). Conclusion: Among coronary heart disease patients after PCI, treatment with clopidogrel does not result in significant decrease in exercise endurance as compared with patients treated with ticagrelor.