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Effect of ticagrelor and prasugrel on remote myocardial inflammation in patients with acute myocardial infarction with ST-elevation: a CMR T1 and T2 mapping study

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An Author Correction to this article was published on 11 April 2023

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Abstract

Purpose: Acute myocardial ischaemia triggers a non-specific inflammatory response of remote myocardium through the increase of plasma concentrations of acute-phase proteins, which causes myocardial oedema. As ticagrelor has been shown to significantly decrease circulating levels of several pro-inflammatory cytokines in patients after acute myocardial infarction with ST-elevation (STEMI), we sought to investigate a potential suppressive effect of ticagrelor over prasugrel on cardiac magnetic resonance (CMR) T1 and T2 values in remote myocardium. Methods: Ninety STEMI patients were prospectively included and randomised to receive either ticagrelor or prasugrel maintenance treatment after successful primary percutaneous coronary intervention. Patients underwent CMR after 2–7 days. The protocol included long and short axis cine imaging, T1 mapping, T2 mapping and late gadolinium enhancement imaging. Results: After excluding 30 patients due to either missing images or insufficient quality of the T1 or T2 maps, 60 patients were included in our analysis. Of those, 29 patients were randomised to the ticagrelor group and 31 patients to the prasugrel group. In the remote myocardium, T1 values did not differ between groups (931.3 [919.4–950.4] ms for ticagrelor vs. 932.6 [915.5–949.2] ms for prasugrel (p = 0.94)), nor did the T2 values (53.8 ± 4.6 ms for ticagrelor vs. 53.7 ± 4.7 ms for prasugrel (p = 0.86)). Also, in the infarcted myocardium, T1 and T2 values did not differ between groups. Conclusion: In revascularised STEMI patients, ticagrelor maintenance therapy did not show superiority over prasugrel in preventing early remote myocardial inflammation as assessed by CMR T1 and T2 mapping.

Graphic abstract

No superiority of ticagrelor over prasugrel on early remote inflammation after ST-elevation myocardial infarction, as assessed by CMR T1 and T2 mapping

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Acknowledgements

Graphical abstract was created with BioRender.com.

Funding

This is a sub study of the REDUCE-MVI trial, which was initiated by the Amsterdam UMC, location VUmc, Amsterdam, the Netherlands with financial support from Astra Zeneca through an unrestricted research grant. In addition, the study was financed by the Ministry of Economic Affairs of the Netherlands by means of a PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands

    Lara S. F. Konijnenberg, Daša Zugwitz, Saloua El Messaoudi, Niels van Royen & Robin Nijveldt

  2. Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Daša Zugwitz

  3. Department of Cardiology, Amsterdam University Medical Center, location VUmc, Amsterdam, the Netherlands

    Henk Everaars, Nina W. van der Hoeven, Ahmet Demirkiran & Albert C. van Rossum

  4. Department of Epidemiology and Biostatistics, Radboud University Medical Center, Nijmegen, the Netherlands

    Laura Rodwell

  5. Department of Cardiology, Isala Clinics, Zwolle, the Netherlands

    Maarten A.H. van Leeuwen

  6. Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands

    Niels P. Riksen

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Konijnenberg, Zugwitz, Everaars, van der Hoeven. The first draft of the manuscript was written by Konijnenberg, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Robin Nijveldt.

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Conflict of interest

D. Zugwitz acknowledges funding received from the European Society of Cardiology, Sophia Antipolis Cedex, France, in form of an ESC Training Grant. Prof. van Royen reports research grants from Astra Zeneca, Abbott, Philips, Biotronik and Top Sector Life Sciences & Health during the conduct of the study. Dr. van Leeuwen has received research grants from Astra Zeneca. Prof. Nijveldt has received research grants from Philips and Biotronik. All other authors have nothing to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local Medical Ethics Review Committee VU University Medical Center Amsterdam.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

Sub study of the REDUCE-MVI trial (NCT02422888), date of registration

21 April 2015

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Konijnenberg, L.S.F., Zugwitz, D., Everaars, H. et al. Effect of ticagrelor and prasugrel on remote myocardial inflammation in patients with acute myocardial infarction with ST-elevation: a CMR T1 and T2 mapping study. Int J Cardiovasc Imaging 39, 767–779 (2023). https://doi.org/10.1007/s10554-022-02765-y

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