Evaluation of Microvascular Injury in Revascularized Patients with ST Elevation Myocardial Infarction Treated with Ticagrelor versus Prasugrel: The REDUCE-MVI Trial

Background: Despite successful restoration of epicardial vessel patency with primary percutaneous coronary intervention (pPCI), coronary microvascular injury (MVI) occurs in a large proportion of STEMI patients, adversely affecting clinical and functional outcome. Ticagrelor has been reported to increase plasma adenosine levels, which might have a protective effect on the microcirculation. We investigated if ticagrelor maintenance therapy after revascularized STEMI is associated with less MVI compared to prasugrel maintenance therapy. Methods: A total of 110 STEMI patients received a loading dose of ticagrelor and were randomized to maintenance therapy of ticagrelor (n=56) or prasugrel (n=54) after pPCI. The primary outcome was MVI at 1 month, as determined with the index of microcirculatory resistance (IMR) in the infarct-related artery. Cardiovascular magnetic resonance imaging was performed during the acute phase and at one month. Results: The primary outcome of IMR was not superior in ticagrelor or pr...