Korean Circ J.  2019 Jul;49(7):586-599. 10.4070/kcj.2018.0415.

Rationale and Design of the High Platelet Inhibition with Ticagrelor to Improve Left Ventricular Remodeling in Patients with ST-Segment Elevation Myocardial Infarction (HEALING-AMI) Trial

Affiliations
  • 1Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea. goodoctor@naver.com
  • 2Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
  • 3Department of Internal Medicine, Changwon Samsung Medical Center, Changwon, Korea.
  • 4Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea.
  • 5Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
  • 6Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
  • 7Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea.
  • 8Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 9Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
  • 10Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
  • 11Department of Cardiology, Singapore National University Heart Centre, Singapore.
  • 12Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.

Abstract

BACKGROUND AND OBJECTIVES
Impaired recovery from left ventricular (LV) dysfunction is a major prognostic factor after myocardial infarction (MI). Because P2Y12 receptor blockade inhibits myocardial injury, ticagrelor with off-target properties may have myocardial protection over clopidogrel. In animal models, ticagrelor vs. clopidogrel protects myocardium against reperfusion injury and improves remodeling after MI. We aimed to investigate the effect of ticagrelor on sequential myocardial remodeling process after MI.
METHODS
High platelet inhibition with ticagrelor to improve LV remodeling in patients with ST-segment elevation MI (HEALING-AMI) is an investigator-initiated, randomized, open-label, assessor-blinded, multi-center trial done at 10 sites in Korea. Patients will be enrolled if they have ST-segment elevation MI (STEMI) treated with primary percutaneous coronary intervention and a planned duration of dual antiplatelet treatment of at least 6 months. Screened patients will be randomly assigned (1:1) using an internet-based randomization with a computer-generated blocking with stratification across study sites to either ticagrelor or clopidogrel treatment. The co-primary primary endpoints are LV remodeling index with three-dimensional echocardiography and the level of N-terminal prohormone B-type natriuretic peptide (NT-proBNP) at 6 months representing post-MI remodeling processes. Changes of LV end-systolic/diastolic volume indices and LV ejection fraction between baseline and 6-month follow-up will be also evaluated. Analysis is per protocol.
CONCLUSIONS
HEALING-AMI is testing the effect of ticagrelor in reducing adverse LV remodeling following STEMI. Our trial would show the benefit of ticagrelor vs. clopidogrel related to the recovery of post-MI LV dysfunction beyond potent platelet inhibition. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02224534

Keyword

Myocardial infarction; Ventricular Remodeling; Platelet; Ticagrelor; Clopidogrel

MeSH Terms

Blood Platelets*
Echocardiography, Three-Dimensional
Follow-Up Studies
Humans
Korea
Models, Animal
Myocardial Infarction*
Myocardium
Natriuretic Peptide, Brain
Percutaneous Coronary Intervention
Random Allocation
Reperfusion Injury
Ventricular Remodeling*
Natriuretic Peptide, Brain
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