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

HEALING-AMI Trial Investigators

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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.

Original languageEnglish
Pages (from-to)586-599
Number of pages14
JournalKorean Circulation Journal
Volume49
Issue number7
DOIs
Publication statusPublished - 2019 Jan 1

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clopidogrel
Ventricular Remodeling
Blood Platelets
Myocardial Infarction
Stroke Volume
Left Ventricular Dysfunction
Three-Dimensional Echocardiography
Brain Natriuretic Peptide
Percutaneous Coronary Intervention
Korea
Random Allocation
ST Elevation Myocardial Infarction
Ticagrelor
Reperfusion Injury
Internet
Myocardium
Animal Models
Research Personnel
Wounds and Injuries
Therapeutics

Keywords

  • Clopidogrel
  • Myocardial infarction
  • Platelet
  • Ticagrelor
  • Ventricular Remodeling

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{eedc34c705b440a6b37689b5b3a64027,
title = "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",
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.",
keywords = "Clopidogrel, Myocardial infarction, Platelet, Ticagrelor, Ventricular Remodeling",
author = "{HEALING-AMI Trial Investigators} and Yongwhi Park and Choi, {Si Wan} and Oh, {Ju Hyeon} and Shin, {Eun Seok} and Lee, {Sang Yeub} and Jeongsu Kim and Weon Kim and Suh, {Jeong Won} and Yang, {Dong Heon} and Hong, {Young Joon} and Chan, {Mark Y.} and Koh, {Jin Sin} and Hwang, {Jin Yong} and Park, {Jae Hyeong} and Jeong, {Young Hoon}",
year = "2019",
month = "1",
day = "1",
doi = "10.4070/kcj.2018.0415",
language = "English",
volume = "49",
pages = "586--599",
journal = "Korean Circulation Journal",
issn = "1738-5520",
publisher = "Korean Society of Circulation",
number = "7",

}

TY - JOUR

T1 - 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

AU - HEALING-AMI Trial Investigators

AU - Park, Yongwhi

AU - Choi, Si Wan

AU - Oh, Ju Hyeon

AU - Shin, Eun Seok

AU - Lee, Sang Yeub

AU - Kim, Jeongsu

AU - Kim, Weon

AU - Suh, Jeong Won

AU - Yang, Dong Heon

AU - Hong, Young Joon

AU - Chan, Mark Y.

AU - Koh, Jin Sin

AU - Hwang, Jin Yong

AU - Park, Jae Hyeong

AU - Jeong, Young Hoon

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - Clopidogrel

KW - Myocardial infarction

KW - Platelet

KW - Ticagrelor

KW - Ventricular Remodeling

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U2 - 10.4070/kcj.2018.0415

DO - 10.4070/kcj.2018.0415

M3 - Article

AN - SCOPUS:85071630452

VL - 49

SP - 586

EP - 599

JO - Korean Circulation Journal

JF - Korean Circulation Journal

SN - 1738-5520

IS - 7

ER -