Key result
Ticagrelor is linked to ~7-fold higher risk of exercise periodic breathing versus thienopyridines.
Why the study?
Ticagrelor induces dyspnoea and central sleep apnoea, and ventilatory disturbances had been observed during exercise, prompting evaluation of whether it increases periodic breathing during exercise and impairs performance.
Does ticagrelor increase the risk of periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation compared to thienopyridines?
Observational (n=84)
No
Does ticagrelor increase the risk of periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation compared to thienopyridines?
Ticagrelor significantly increases the risk of exercise-induced periodic breathing in coronary patients, but does not impair gas exchange or aerobic capacity, supporting its continued use during cardiac rehabilitation.
Answers are grounded in this paper and cite their sources.
May warrant ventilatory monitoring on ticagrelor during rehab; leaves open clinical relevance and need for regimen changes.
PURPOSE: Ticagrelor, a reversible P2Y12 inhibitor widely prescribed after acute coronary syndrome (ACS), induces dyspnoea and central sleep apnoea through effects on respiratory centre activity. During cardiac rehabilitation, we observed apparent ventilatory disturbances in patients receiving ticagrelor during cardiopulmonary exercise tests (CPET). This study aimed to evaluate whether ticagrelor significantly increases the risk of periodic breathing during exercise and whether this impairs functional or metabolic performance. METHODS: We performed a single-centre retrospective observational study (October 2012-December 2021) including 84 coronary patients (36 ticagrelor, 48 thienopyridines) who underwent cardiac rehabilitation following angioplasty with coronary stenting. The primary endpoint was exercise-induced periodic breathing, defined as ≥ 3 consecutive oscillation cycles of VE, VO2, or VCO2 with amplitude ≥ 30% of mean values. Secondary endpoints were peak VO2, end-tidal CO2 pressure (PETCO2), and ventilatory equivalent for CO2 (EqCO2) at peak VO2. Univariable and multivariable logistic and linear regression analyses were performed (R v4.0.0). RESULTS: Ticagrelor was independently associated with a > 7-fold increased risk of periodic breathing during exercise in both univariable (OR = 7.82, 95% CI [2.80-24.72], p < 0.001) and multivariable analyses (OR = 7.17, 95% CI [2.31-25.19], p < 0.001), after adjustment for age, BMI, LVEF, smoking, obstructive lung disease, and neurological risk. No significant effect on PETCO2 (p = 0.759) or EqCO2 (p = 0.442) at peak VO2 was observed. In multivariable analysis, patients on ticagrelor had significantly higher peak VO2 than those on thienopyridines (+ 3.17 ml/min/kg, 95% CI [1.34-4.99], p < 0.001). CONCLUSION: Ticagrelor is significantly associated with periodic breathing during exercise in coronary patients undergoing cardiac rehabilitation. However, this ventilatory disturbance does not impair gas exchange or aerobic capacity. These findings support maintaining ticagrelor therapy in patients presenting with exercise-induced periodic breathing.
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Pointel et al. (2026) conducted an observational in Coronary patients undergoing cardiac rehabilitation following angioplasty with coronary stenting (n=84). Ticagrelor vs. Thienopyridines (clopidogrel or prasugrel) was evaluated on Exercise-induced periodic breathing (≥ 3 consecutive oscillation cycles of VE, VO2, or VCO2 with amplitude ≥ 30% of mean values) (OR 7.17, 95% CI 2.31-25.19, p=<0.001). Ticagrelor was independently associated with a more than 7-fold increased risk of periodic breathing during exercise (OR 7.17) compared to thienopyridines in coronary patients undergoing cardiac rehabilitation.
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