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Impact of residual platelet reactivity on reperfusion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Authors :
Capranzano P
Capodanno D
Bucciarelli-Ducci C
Gargiulo G
Tamburino C
Francaviglia B
Ohno Y
La Manna A
Antonella S
Attizzani GF
Angiolillo DJ
Tamburino C
Source :
European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2016 Sep; Vol. 5 (5), pp. 475-86. Date of Electronic Publication: 2016 Jan 12.
Publication Year :
2016

Abstract

Aim: Whether high platelet reactivity (HPR) immediately after diagnostic angiography is associated with worse coronary reperfusion prior to and after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is unknown. This study aimed to assess the impact of P2Y12-mediated HPR on angiographic outcomes in patients with STEMI undergoing PPCI.<br />Methods: STEMI patients undergoing PPCI and pretreated with a P2Y12 receptor antagonist underwent platelet function testing with the VerifyNow™ assay at the time of angiography. Light transmission aggregometry (LTA) was performed in a subgroup. HPR was defined according to expert consensus definitions. Pre-PCI coronary patency, thrombotic burden and indices of impaired post-PCI reperfusion were compared between HPR and non-HPR patients.<br />Results: Among 164 patients, the prevalence of VerifyNow™-derived HPR was 71.3% at a median (interquartile range (IQR)) of 55 (40-75) minutes after a P2Y12 inhibitor loading dose. Compared with non-HPR patients, those with HPR had significantly lower rates of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grades 2 or 3 (51.1% vs. 32.5%, p = 0.04), higher rates of thrombus score (TS) grade 3/4 (29.8% vs. 52.1%, p = 0.015) and 4 (14.9% vs. 32.5%, p = 0.037) and lower median (IQR) corrected TIMI frame count (cTFC; 23.2 (15.8-32.5) vs. 26.0 (21.0-35.0), p = 0.02), respectively. These findings were consistent using LTA-based data. HPR and TS grade 4 were predictors of higher cTFC.<br />Conclusions: In patients with STEMI undergoing PPCI pretreated with P2Y12 receptor inhibitors, pre-PPCI HPR was found to be associated with lower pre-PCI coronary patency, higher thrombotic burden and a worse index of post-PCI coronary reperfusion.<br /> (© The European Society of Cardiology 2016.)

Details

Language :
English
ISSN :
2048-8734
Volume :
5
Issue :
5
Database :
MEDLINE
Journal :
European heart journal. Acute cardiovascular care
Publication Type :
Academic Journal
Accession number :
26758542
Full Text :
https://doi.org/10.1177/2048872615624849