Author + information
- Received March 20, 2019
- Revision received May 6, 2019
- Accepted May 13, 2019
- Published online July 6, 2020.
- Alastair J. Moss, MDa,∗ (, )
- Marc R. Dweck, MD, PhDa,
- Mhairi K. Doris, MDa,
- Jack P.M. Andrews, MDa,
- Rong Bing, MDa,
- Rachael O. Forsythe, MD, PhDa,
- Timothy R. Cartlidge, MDa,
- Tania A. Pawade, MD, PhDa,
- Marwa Daghem, MDa,
- Jennifer B. Raftis, PhDb,
- Michelle C. Williams, MDa,c,
- Edwin J.R. van Beek, MD, PhDa,c,
- Laura Forsyth, PhDd,
- Steff C. Lewis, PhDd,
- Robert J. Lee, MScd,
- Anoop S.V. Shah, MD, PhDa,e,
- Nicholas L. Mills, MD, PhDa,e,
- David E. Newby, MD, PhDa,c and
- Philip D. Adamson, MD, PhDa,f
- aBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
- bMedical Research Council Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- cEdinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- dEdinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, United Kingdom
- eUsher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- fChristchurch Heart Institute, University of Otago, Christchurch, New Zealand
- ↵∗Address for correspondence:
Dr. Alastair J. Moss, BHF Centre for Cardiovascular Science, Chancellor’s Building, University of Edinburgh, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom.
Objectives The goal of this study was to determine whether ticagrelor reduces high-sensitivity troponin I concentrations in patients with established coronary artery disease and high-risk coronary plaque.
Background High-risk coronary atherosclerotic plaque is associated with higher plasma troponin concentrations suggesting ongoing myocardial injury that may be a target for dual antiplatelet therapy.
Methods In a randomized, double-blind, placebo-controlled trial, patients with multivessel coronary artery disease underwent coronary 18F-fluoride positron emission tomography/coronary computed tomography scanning and measurement of high-sensitivity cardiac troponin I. Patients were randomized (1:1) to receive ticagrelor 90 mg twice daily or matched placebo. The primary endpoint was troponin I concentration at 30 days in patients with increased coronary 18F-fluoride uptake.
Results In total, 202 patients were randomized to treatment, and 191 met the pre-specified criteria for inclusion in the primary analysis. In patients with increased coronary 18F-fluoride uptake (120 of 191), there was no evidence that ticagrelor had an effect on plasma troponin concentrations at 30 days (ratio of geometric means for ticagrelor vs. placebo: 1.11; 95% confidence interval: 0.90 to 1.36; p = 0.32). Over 1 year, ticagrelor had no effect on troponin concentrations in patients with increased coronary 18F-fluoride uptake (ratio of geometric means: 0.86; 95% confidence interval: 0.63 to 1.17; p = 0.33).
Conclusions Dual antiplatelet therapy with ticagrelor did not reduce plasma troponin concentrations in patients with high-risk coronary plaque, suggesting that subclinical plaque thrombosis does not contribute to ongoing myocardial injury in this setting. (Dual Antiplatelet Therapy to Reduce Myocardial Injury [DIAMOND]; NCT02110303)
This trial was funded by a Wellcome Trust Senior Investigator Award (WT103782AIA) and an unrestricted educational grant from AstraZeneca. The Edinburgh Clinical Research Facilities and Edinburgh Imaging facility is supported by the National Health Service Research Scotland through the National Health Service Lothian Health Board. Dr. Moss is supported by the Chief Scientific Office of the Scottish Government (CGA/17/53). Dr. Newby is supported by the British Heart Foundation (CH/09/002, RG/16/10/32375, RE/13/3/30183); is a recipient of a Wellcome Trust Senior Investigator Award (WT103782AIA); and has received honoraria for consultancy and lectures from AstraZeneca. Dr. Doris is supported by the British Heart Foundation (FS/17/79/33226). Dr. Shah is supported by an Intermediate Clinical Research Fellowship from the British Heart Foundation (FS/19/17/34172). Dr. van Beek is supported by the Scottish Imaging Network: A Platform for Scientific Excellence; has received research support from Siemens Healthineers and GE Healthcare; is a member of the Advisory Board for Aidence; is an owner/founder of QCTIS Ltd.; and has served as a consultant for Mentholatum. Dr. Mills is supported by the Butler Senior Clinical Research Fellowship (FS/16/14/32023) from the British Heart Foundation; and has received honoraria and research grants from Abbott Diagnostics and Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received March 20, 2019.
- Revision received May 6, 2019.
- Accepted May 13, 2019.
- 2020 The Authors