Ticagrelor versus prasugrel in acute coronary syndrome significantly altered plasma metabolites, most notably DHEAS (p=0.0004, FC=-1.66) and 3-Met-His (p=0.0024, FC=1.75).
Does ticagrelor compared to prasugrel alter plasma metabolomic profiles in patients with acute coronary syndrome?
Ticagrelor and prasugrel induce distinct metabolomic profiles in ACS patients, with ticagrelor associated with lower DHEAS levels which may mechanistically contribute to its known dyspnea side effect.
Absolute Event Rate: 0% vs 0%
Abstract Background Ticagrelor and prasugrel are key components in the treatment of patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI). However, both antiplatelet agents exhibit pleiotropic actions, leading to several side effects. In previous trials, ticagrelor demonstrated the induction of dyspnea symptoms in patients. Purpose The objective of this study was to assess novel metabolomic indicators associated with the effects of ticagrelor and prasugrel using targeted metabolomic tools. Methods EDTA plasma samples from 207 consecutive ACS patients treated with either prasugrel (n = 106) or ticagrelor (n = 101) were analyzed using a targeted assay for up to 631 metabolites. Results Several metabolites were significantly (p 0.05) different between the treatment groups. Among these, DHEAS and 3-Met-His had most significant changes (p = 0.0004, FC = -1.66 and p = 0.0024, FC = 1.75, respectively). After stratification for key risk factors, lysoPC a C17:0, 3-Met-His, and DHEAS remained significantly altered. In subgroup analysis, patients with diabetes showed distinct metabolic patterns, including increased TMAO and choline and decreased GUDCA, compared to non-diabetics. Differences were also observed in hexoses, Met-SO, and TCDCA levels. Conclusion A novel hypothesis regarding the pleiotropic actions of ticagrelor suggests that dyspnea may involve low levels of DHEAS. Additionally, decreased methionine and methionine sulfoxide levels may reflect reduced oxidative stress. Diabetic patients exhibited a metabolic shift and altered gut microbiome related metabolites, such as TMAO, contributing to a more ischemic profile.For image description, please refer to the figure legend and surrounding text.
Rogozarski et al. (Sun,) reported a other. Ticagrelor versus prasugrel in acute coronary syndrome significantly altered plasma metabolites, most notably DHEAS (p=0.0004, FC=-1.66) and 3-Met-His (p=0.0024, FC=1.75).