Abstract 5768: The Effect of Ticagrelor on Cardiopulmonary Function in Patients With Stable Coronary Artery Disease

Background: A higher incidence of dyspnea has been observed in patients treated with ticagrelor (T) versus clopidogrel (C). As part of a multicenter, randomized, double-blind, parallel-group study (the ONSET-OFFSET study) in patients with stable coronary artery disease (CAD), we investigated whether T treatment is associated with any change in cardiopulmonary function. Methods: A total of 123 stable aspirin-treated CAD patients were randomized to T (180 mg load then 90 mg bid [n=57]), C (600 mg load then 75 mg qd [n=54]), or placebo (n=12) for 6 weeks. Echocardiography, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurements, and comprehensive pulmonary function tests were performed prior to (baseline) and 6 weeks after drug administration and/or following development of dyspnea. ANCOVA was used to analyze cardiopulmonary function changes from baseline. Results: The incidence of new-onset dyspnea following randomization was 24.6%, 5.6%, and 0% in the T, C, and placebo groups, respectively. The majority of instances were mild and/or lasted less than 24 h, although 3 patients on T versus 0 on C or placebo discontinued due to dyspnea. Seven of 16 and 8/16 patients experiencing dyspnea did so within 24 h and 1 week, respectively, after drug administration. In all treatment groups, there were no significant changes between baseline and 6 weeks in any of the cardiopulmonary function parameters (Table ). Subgroup analysis of patients experiencing dyspnea also showed no significant changes in these parameters. C max and AUC 0-inf were similar between T-treated patients who experienced dyspnea and those who did not. Conclusions: Ticagrelor treatment had no effect on cardiopulmonary function in stable CAD patients. Dyspnea occurred with a higher frequency with ticagrelor versus clopidogrel but was not accompanied by any significant change in cardiopulmonary function.