Factors determining ticagrelor-induced dyspnea in patients with acute coronary syndrome

Abstract

Background: Based on the guidelines by the European Society of Cardiology, dual antiplatelet therapy for up to 12 months is recommended for patients with acute coronary syndrome (ACS), who underwent PTCA with stent implantation. Ticagrelor in a combination with aspirin as a first-line therapy for patients with ACS irrespective of the initial treatment strategy. The most frequent clinical challenge associated with ticagrelor administration is its premature discontinuation attributed to sudden-onset dyspnea or bleeding. Premature discontinuation of ticagrelor leads to an increased risk of stent thrombosis and recurrent ACS, which are associated with significantly greater mortality, longer hospital stay, and worse patient’s functional status and quality of life. Aim: The aim of this study was to determine clinical and genetic factors predicting the development of dyspnea in patients receiving ticagrelor. Results: A lower ADP HS value possibly indicates greater ticagrelor activity and probably a higher plasma concentration of this drug. ADP HS value of ≤ 19.5 U was associated with more than 4-fold greater risk of developing dyspnea (OR = 4.07, p ≤ 0.001). Atorvastatin might have an impact on the occurrence of ticagrelor-related dyspnea by affecting ticagrelor metabolism. The administration of any dose of atorvastatin lower than 80 mg (or no atorvastatin at all) increased the likelihood of developing ticagrelor-related dyspnea by more than 2 times (OR = 2.18; p = 0.012). No impact of any genetic variant on the development of dyspnea was determined. Conclusions: A lower ADP HS was related to the occurrence of dyspnea. The administration of any dose of atorvastatin lower than 80 mg (or no atorvastatin at all) increased the likelihood of developing ticagrelor-related dyspnea by more than 2 times.No impact of any genetic variant on the development of dyspnea was determined.