ST Elevation Myocardial Infarction Clinical Trial
Official title:
A Randomised Mechanistic Study Comparing the Effects of Different Anti-platelet Combinations (Ticagrelor vs. Placebo/ Clopidogrel) With Aspirin in Patients Presenting With Anterior STEMI Treated With Primary PCI
This is a single-centred, double blind randomized controlled trial comparing ticagrelor with placebo in clopidogrel and aspirin loaded patients.
The very early benefit of ticagrelor in STEMI is co-mediated by adenosine cardioprotection
maintaining/ improving myocardial microcirculatory function, as well as via platelet
inhibition or possibly other pleiotropic effects.
Ticagrelor increases circulating adenosine by reducing cellular re-uptake. Adenosine is a
cardioprotective agent that utilizes cellular survival kinase pathways that may have
beneficial effects on the microcirculation and myocardium in patients presenting with STEMI.
Adenosine is currently used as a treatment for no-reflow and improves MVO post-STEMI when
administered during PPCI. A recent study of healthy volunteers has confirmed that
non-invasive coronary flow is augmented by ticagrelor and that this is mediated by
adenosine. The Investigators propose that the very early beneficial effects of Ticagrelor in
ACS may be adenosine mediated cardioprotection, rather than only due to an antiplatelet
effect. This important research is original and a natural progression of the ticagrelor
story. It expands the adenosine hypothesis and mode of action of ticagrelor and addresses a
novel cardioprotective/ microcirculatory mechanism of action.
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