Fig. 2

The BATTLE-AMI hypothesis – microcirculation. Microcirculation will be improved by adenosine and nitric oxide. Ticagrelor increases intra- and extracellular levels of adenosine by blocking the adenosine transporter ENT1. Rosuvastatin increases nitric oxide availability through the decrease in the intracellular signaling mediated by Rho GTPases. Decrease in Rho protein is followed by increased bioavailability of nitric oxide, promoting vasodilation. Thus, the synergism between rosuvastatin and ticagrelor will improve the microcirculation of the ischemic myocardium decreasing the final infarcted mass. The absence of effect in adenosine levels following clopidogrel use and the characteristics of simvastatin as a prodrug might have lower beneficial effect on the microcirculation