{"id":"2c4971592484","type":"article","url":"https://hartvaat.nl/2023/12/20/ticagrelor-versus-prasugrel-en-coronaire-microcirculatie-bij-pci/","title":"Ticagrelor versus prasugrel en coronaire microcirculatie bij PCI","title_en":"Effects of ticagrelor and prasugrel on coronary microcirculation in elective percutaneous coronary intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["percutane-coronaire-interventie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2022-321868","source_url":"https://doi.org/10.1136/heartjnl-2022-321868","authors":["Fabio Mangiacapra","Iginio Colaiori","Giuseppe Di Gioia","Mariano Pellicano","Alex Heyse","Luca Paolucci","Aaron Peace","Jozef Bartunek","Bernard de Bruyne","Emanuele Barbato"],"significance":5,"published":"2023-12-20","source_date":"2023-12-20","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This study compared the effects of ticagrelor and prasugrel on coronary microcirculation during elective PCI, finding similar improvements in absolute coronary blood flow with both agents.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","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":"Studie vergeleek het effect van ticagrelor en prasugrel op de coronaire microcirculatie bij electieve PCI. Beide middelen toonden vergelijkbare effecten op de absolute coronaire bloedstroom en microvasculaire weerstand.","abstract_original":"OBJECTIVE: To compare the effects of ticagrelor and prasugrel on absolute coronary blood flow (Q) and microvascular resistance (R) in patients with stable coronary artery disease (CAD) treated with elective percutaneous coronary intervention (PCI) (NCT05643586). Besides being at least as effective as prasugrel in inhibiting platelet aggregation, ticagrelor has been shown to have additional properties potentially affecting coronary microcirculation. METHODS: We randomly assigned 50 patients to ticagrelor (180 mg) or prasugrel (60 mg) at least 12 hours before intervention. Continuous thermodilution was used to measure Q and R before and after PCI. Platelet reactivity was measured before PCI. Troponin I was measured before, 8 and 24 hours after PCI. RESULTS: At baseline, fractional flow reserve, Q and R were similar in two study groups. Patients in the ticagrelor group showed higher post-PCI Q (242±49 vs 205±53 mL/min, p=0.015) and lower R values (311 (263, 366) vs 362 (319, 382) mm Hg/L/min, p=0.032). Platelet reactivity showed a negative correlation with periprocedural variation of Q values (r=-0.582, p<0.001) and a positive correlation with periprocedural variation of R values (r=0.645, p<0.001). The periprocedural increase in high-sensitivity troponin I was significantly lower in the ticagrelor compared with the prasugrel group (5 (4, 9) ng/mL vs 14 (10, 24) ng/mL, p<0.001). CONCLUSIONS: In patients with stable CAD undergoing PCI, pretreatment with a loading dose of ticagrelor compared with prasugrel improves post-procedural coronary flow and microvascular function and seems to reduce the related myocardial injury."}