Coronary Microvascular Disease Clinical Trial
Official title:
Effect of Ticagrelor and Clopidogrel on Coronary Microcirculation in Patients With Acute Myocardial Infarction
Of the patients diagnosed with ST-segment elevation myocardial infarction (STEMI) who
underwent reperfusion therapy and have thrombolysis in myocardial infarction (TIMI) 3 flow,
about 40% have flow alterations in the coronary microcirculation, which leads to worse
remodeling of the left ventricle with a consequent increase in the mortality of this
population. Clopidogrel is the only known antiplatelet medication that brings benefits to the
coronary microcirculation. Ticagrelor is significantly superior to clopidogrel in terms of
decreasing mortality.
The main objective of this study is to compare the effect of ticagrelor versus clopidogrel on
the coronary microcirculation by the Myocardial Perfusion Score Index (MPSI) obtained using
Microbubble Contrasted Echocardiography (MCE) in patients who have STEMI and treated with
thrombolysis.
The present project should prospectively include patients participating in the TREAT study,
who are including individuals with Acute Myocardial Infarction (AMI) treated with
fibrinolytic and openly randomized to ticagrelor or clopidogrel within 24 hours of the onset
of symptoms. Patients will be submitted to coronary angiography within 4 (± 2) days of the
onset of symptoms, and those who, at the end of coronary angiography, present residual
obstruction in the culprit vessel of less than 50% and have TIMI 3 flow, regardless of have
undergone percutaneous coronary intervention will be included.
Following, on day 2 (± 1) days after coronary angiography (therefore 6 ± 3 days from the
onset of symptoms), they will be submitted to microcirculation perfusion evaluation by means
of MPSI (myocardial perfusion score index) obtained by MCE (Microbubble contrasted
echocardiography) - blood collection for evaluation of Platelet aggregability will be
performed immediately prior to the start of MCE. Finally, in order to evaluate left
ventricular remodeling, patients will undergo a new Echocardiography within 90 (± 10) days
after discharge.
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