{"id":"e08e3d73d418","type":"article","url":"https://hartvaat.nl/2019/01/29/microvasculaire-schade-bij-gerevasculariseerde-stemi-met-ticagrelor-versus-prasu/","title":"Microvasculaire schade bij gerevasculariseerde STEMI met ticagrelor versus prasugrel","title_en":"Evaluation of Microvascular Injury in Revascularized Patients With ST-Segment-Elevation Myocardial Infarction Treated With Ticagrelor Versus Prasugrel.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.118.035931","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.118.035931","authors":["Maarten A H van Leeuwen","Nina W van der Hoeven","Gladys N Janssens","Henk Everaars","Alexander Nap","Jorrit S Lemkes","Guus A de Waard","Peter M van de Ven","Albert C van Rossum","Tim J F Ten Cate","Jan J Piek","Clemens von Birgelen","Javier Escaned","Marco Valgimigli","Roberto Diletti","Niels P Riksen","Nicolas M van Mieghem","Robin Nijveldt","Niels van Royen"],"significance":5,"published":"2019-01-29","source_date":"2019-01-29","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/diagnostiek/cardiale-mri/"],"congress":"","summary_en":"This cardiac MRI study compared microvascular injury between ticagrelor- and prasugrel-treated STEMI patients, evaluating whether the P2Y12 inhibitor choice affects myocardial tissue-level reperfusion quality.","created":"2026-07-03T10:27:44Z","updated":"2026-07-03T13:26:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van microvasculaire schade bij STEMI behandeld met ticagrelor versus prasugrel middels cardiale MRI.","abstract_original":"BACKGROUND: Despite successful restoration of epicardial vessel patency with primary percutaneous coronary intervention, coronary microvascular injury occurs in a large proportion of patients with ST-segment-elevation myocardial infarction, adversely affecting clinical and functional outcome. Ticagrelor has been reported to increase plasma adenosine levels, which might have a protective effect on the microcirculation. We investigated whether ticagrelor maintenance therapy after revascularized ST-segment-elevation myocardial infarction is associated with less coronary microvascular injury compared to prasugrel maintenance therapy. METHODS: A total of 110 patients with ST-segment-elevation myocardial infarction received a loading dose of ticagrelor and were randomized to maintenance therapy of ticagrelor (n=56) or prasugrel (n=54) after primary percutaneous coronary intervention. The primary outcome was coronary microvascular injury at 1 month, as determined with the index of microcirculatory resistance in the infarct-related artery. Cardiovascular magnetic resonance imaging was performed during the acute phase and at 1 month. RESULTS: The primary outcome of index of microcirculatory resistance was not superior in ticagrelor- or prasugrel-treated patients (ticagrelor, 21 [interquartile range, 15-39] U; prasugrel, 18 [interquartile range, 11-29] U; P=0.08). Recovery of microcirculatory resistance over time was not better in patients with ticagrelor versus prasugrel (ticagrelor, -13.9 U; prasugrel, -13.5 U; P=0.96). Intramyocardial hemorrhage was observed less frequently in patients receiving ticagrelor (23% versus 43%; P=0.04). At 1 month, no difference in infarct size was observed (ticagrelor, 7.6 [interquartile range, 3.7-14.4] g, prasugrel 9.9 [interquartile range, 5.7-16.6] g; P=0.17). The occurrence of microvascular obstruction was not different in patients on ticagrelor (28%) or prasugrel (41%; P=0.35). Plasma adenosine concentrations were not different during the index procedure and during maintenance therapy with ticagrelor or prasugrel. CONCLUSIONS: In patients with ST-segment-elevation myocardial infarction, ticagrelor maintenance therapy was not superior to prasugrel in preventing coronary microvascular injury in the infarct-related territory as assessed by the index of microcirculatory resistance, and this resulted in a comparable infarct size at 1 month. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02422888."}