nirs ticagrelor evaluation

Conditions: Coronary Artery Disease

Summary: the impact of ticagrelor on coronary atherosclerotic lipid pool and inflammation assessed by near-infrared spectroscopy study will evaluate whether ticagrelor leads to a 20% reduction in the lcbi with nirs/ivus suggesting coronary plaque stabilization and reduced inflammation in patients already on long-term statin therapy undergoing non-urgent pci. it is hypothesized that the treatment with ticagrelor following pci will lead to a significant 20% reduction in the lipid pool as measured by nirs/ivus at follow-up when compared with baseline imaging, suggesting a reduction in inflammation and stabilization of the lipid core in atherosclerotic lesions not treated during the index procedure.

single-center, open-label study of the effect of ticagrelor on the reduction in the lipid pool in 30 patients with multi-vessel cad 2 treatment periods over 6 months, with 2 additional follow-up phone calls at 1 and 3 months. non-urgent pci requiring stent placement and evaluation by nirs/ivus at baseline and 6 month follow up a second concomitant coronary lesion with diameter stenosis greater than 50% will also be imaged using nirs/ivus. patients will be discharged on a ticagrelor regiment of 90 mg twice a day for the 6 month study. blood samples will be drawn at baseline prior to ticagrelor being administered and again at follow up. inclusion criteria: * female (post menopausal or surgically sterile) and/or male aged 18 years or older * multi-vessel coronary artery disease * statin therapy for minimum of 6 weeks prior to enrollment in the study with no plan for further adjustment * non-emergent pci for acs with stent placement requiring dual-antiplatelet therapy * ability to safely perform nirs/ivus for a concomitant non-culprit lesion with diameter stenosis ≥ 50% that was not treated with pci * willing and able to sign informed consent and participate in follow-up exclusion criteria: * thienopyridine or ticagrelor use in the last month * need for coronary artery bypass surgery or other surgeries during the follow-up period * documented medication non-compliance * chronic inflammatory disorder or treatment with anti-inflammatory or immunosuppressive drugs * prior or current malignancy within the last 5 years * concomitant severe illness or reduced life expectancy that will prevent follow-up cardiac catheterization * active infection * pregnant or lactating women * end-stage renal disease * history of intracranial hemorrhage * active pathological bleeding * known sever hepatic impairment * known hypersensitivity to ticagrelor study procedures: after consent is obtained non-urgent pci requiring stent placement and evaluation by nirs/ivus at baseline is performed and once again at 6 month follow up. a second concomitant coronary lesion with diameter stenosis greater than 50% will also be imaged using nirs/ivus. patients will be discharged on a ticagrelor regiment of 90 mg twice a day for the 6 month study.blood samples will be drawn at baseline prior to ticagrelor being administered and again at follow up. there will be 1 month phone follow up, 3 month phone follow up and a 6 month clinical follow up that includes collecting blood, repeat catheterization, and repeat nirs/ivus procedure.

Eligibility criteria:
inclusion criteria: * • female (post menopausal or surgically sterile) and/or male aged 18 years or older * multi-vessel coronary artery disease cad * statin therapy for minimum of 6 weeks prior to enrollment in the study with no plan for further adjustment * non-emergent pci for acs with stent placement requiring dual-antiplatelet therapy * ability to safely perform nirs/ivus for a concomitant non-culprit lesion with diameter stenosis ≥50% that was not treated with pci * willing and able to sign informed consent and participate in follow-up exclusion criteria: * thienopyridine or ticagrelor use in the last month * need for coronary artery bypass surgery or other surgeries during the follow-up period * documented medication non-compliance * chronic inflammatory disorder or treatment with anti-inflammatory or immunosuppressive drugs * prior or current malignancy within the last 5 years * concomitant severe illness or reduced life expectancy that will prevent follow-up cardiac catheterization * active infection * pregnant or lactating women * end-stage renal disease * history of intracranial hemorrhage * active pathological bleeding * known severe hepatic impairment * known hypersensitivity to ticagrelor