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Observational study of platelet reactivity in patients presenting with ST-segment elevation myocardial infarction due to coronary stent thrombosis undergoing primary percutaneous coronary intervention: results from the European PREvention of Stent Thrombosis by an Interdisciplinary Global European Effort Registry

Observational study of platelet reactivity in patients presenting with ST-segment elevation myocardial infarction due to coronary stent thrombosis undergoing primary percutaneous coronary intervention: results from the European PREvention of Stent Thrombosis by an Interdisciplinary Global European Effort Registry
Observational study of platelet reactivity in patients presenting with ST-segment elevation myocardial infarction due to coronary stent thrombosis undergoing primary percutaneous coronary intervention: results from the European PREvention of Stent Thrombosis by an Interdisciplinary Global European Effort Registry

Objectives: high platelet reactivity (HPR) was studied in patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) undergoing immediate percutaneous coronary intervention (PCI).

Background: HPR on P2Y12 inhibitors (HPR-ADP) is frequently observed in stable patients who have experienced ST. The HPR rates in patients presenting with ST for immediate PCI are unknown.

Methods: consecutive patients presenting with definite ST were included in a multicenter ST registry. Platelet reactivity was measured before immediate PCI with the VerifyNow P2Y12 or Aspirin assay.

Results: platelet reactivity was measured in 129 ST patients presenting with STEMI undergoing immediate PCI. HPR-ADP was observed in 76% of the patients, and HPR on aspirin (HPR-AA) was observed in 13% of the patients. HPR rates were similar in patients who were on maintenance P2Y12 inhibitor or aspirin since stent placement versus those without these medications. In addition, HPR-ADP was similar in patients loaded with a P2Y12 inhibitor shortly before immediate PCI versus those who were not. In contrast, HPR-AA trended to be lower in patients loaded with aspirin as compared with those not loaded.

Conclusions: approximately 3 out of 4 ST patients with STEMI undergoing immediate PCI had HPR-ADP, and 13% had HPR-AA. Whether patients were on maintenance antiplatelet therapy while developing ST or loaded with P2Y12 inhibitors shortly before undergoing immediate PCI had no influence on the HPR rates. This raises concerns that the majority of patients with ST have suboptimal platelet inhibition undergoing immediate PCI.

Adenosine Diphosphate/blood, Aged, Biomarkers/blood, Blood Platelets/drug effects, Coronary Thrombosis/blood, Drug Resistance, Europe, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention/adverse effects, Platelet Aggregation Inhibitors/adverse effects, Platelet Function Tests, Purinergic P2Y Receptor Antagonists/adverse effects, Receptors, Purinergic P2Y12/blood, Recurrence, Registries, Risk Factors, ST Elevation Myocardial Infarction/blood, Stents/adverse effects, Time Factors, Treatment Outcome
1936-8798
2548-2556
Godschalk, Thea C
2a10799a-84d3-49a5-821c-253ae06b4351
Byrne, Robert A
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Adriaenssens, Tom
989474e8-65c9-4664-90f7-e651c56ec1ad
Malik, Nikesh
f6a8a183-06ad-406f-8548-19a134cf8523
Feldman, Laurent J
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Guagliumi, Giulio
913c5cd5-0629-460c-866e-d01a7fb09232
Alfonso, Fernando
2e0245f1-f1e6-4ee0-897c-21af4aea66cb
Neumann, Franz-Josef
d713a062-7de6-4369-b630-c855e0a1d92f
Trenk, Dietmar
ecd821c2-e17c-42bf-95da-067d2f2d856d
Joner, Michael
6ff9caee-dcd9-4706-af73-f09c918e988b
Schulz, Christian
68ce36e3-19b9-49c8-8bac-465fcf1625c9
Steg, Philippe G
1cebb409-f5f0-46a0-8682-34fd905aec17
Goodall, Alison H
41ee1853-c935-4974-aa1d-78b128927540
Wojdyla, Roman
28de0130-f954-469e-8032-bfcbe7f9deb2
Dudek, Dariusz
6fdd290d-24b9-4f74-b765-a7f030cd66d7
Wykrzykowska, Joanna J
7f1370a3-8611-4974-9ee6-762884244eb0
Hlinomaz, Ota
56bec5d5-d81c-4d71-b3fc-6d344dd6d269
Zaman, Azfar G
dadf7e3e-f6b2-429b-8344-b84347f68da5
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Dens, Jo
ad465626-df59-4ac0-a111-3a1bf952efdf
Sinnaeve, Peter
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Desmet, Walter
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Gershlick, Anthony H
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Kastrati, Adnan
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Massberg, Steffen
534c208a-9d25-47c7-ad9d-5701f88365bc
Ten Berg, Jurriën M
1007a2b6-e168-43a2-8d86-0d563382b809
et al.
PRESTIGE Investigators
Godschalk, Thea C
2a10799a-84d3-49a5-821c-253ae06b4351
Byrne, Robert A
85863b99-534c-4bfd-8a36-3cdb796c0882
Adriaenssens, Tom
989474e8-65c9-4664-90f7-e651c56ec1ad
Malik, Nikesh
f6a8a183-06ad-406f-8548-19a134cf8523
Feldman, Laurent J
7a2ecb8a-a439-4fbd-8f90-aa7e6187fa2c
Guagliumi, Giulio
913c5cd5-0629-460c-866e-d01a7fb09232
Alfonso, Fernando
2e0245f1-f1e6-4ee0-897c-21af4aea66cb
Neumann, Franz-Josef
d713a062-7de6-4369-b630-c855e0a1d92f
Trenk, Dietmar
ecd821c2-e17c-42bf-95da-067d2f2d856d
Joner, Michael
6ff9caee-dcd9-4706-af73-f09c918e988b
Schulz, Christian
68ce36e3-19b9-49c8-8bac-465fcf1625c9
Steg, Philippe G
1cebb409-f5f0-46a0-8682-34fd905aec17
Goodall, Alison H
41ee1853-c935-4974-aa1d-78b128927540
Wojdyla, Roman
28de0130-f954-469e-8032-bfcbe7f9deb2
Dudek, Dariusz
6fdd290d-24b9-4f74-b765-a7f030cd66d7
Wykrzykowska, Joanna J
7f1370a3-8611-4974-9ee6-762884244eb0
Hlinomaz, Ota
56bec5d5-d81c-4d71-b3fc-6d344dd6d269
Zaman, Azfar G
dadf7e3e-f6b2-429b-8344-b84347f68da5
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Dens, Jo
ad465626-df59-4ac0-a111-3a1bf952efdf
Sinnaeve, Peter
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Desmet, Walter
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Gershlick, Anthony H
5beb7f92-68f7-41df-ba72-ef3d2cdf20b9
Kastrati, Adnan
7dd6daf1-9530-416b-b592-04b48e3a760c
Massberg, Steffen
534c208a-9d25-47c7-ad9d-5701f88365bc
Ten Berg, Jurriën M
1007a2b6-e168-43a2-8d86-0d563382b809

Godschalk, Thea C, Byrne, Robert A and Adriaenssens, Tom , et al. and PRESTIGE Investigators (2017) Observational study of platelet reactivity in patients presenting with ST-segment elevation myocardial infarction due to coronary stent thrombosis undergoing primary percutaneous coronary intervention: results from the European PREvention of Stent Thrombosis by an Interdisciplinary Global European Effort Registry. JACC Cardiovascular Interventions, 10 (24), 2548-2556. (doi:10.1016/j.jcin.2017.09.019).

Record type: Article

Abstract

Objectives: high platelet reactivity (HPR) was studied in patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) undergoing immediate percutaneous coronary intervention (PCI).

Background: HPR on P2Y12 inhibitors (HPR-ADP) is frequently observed in stable patients who have experienced ST. The HPR rates in patients presenting with ST for immediate PCI are unknown.

Methods: consecutive patients presenting with definite ST were included in a multicenter ST registry. Platelet reactivity was measured before immediate PCI with the VerifyNow P2Y12 or Aspirin assay.

Results: platelet reactivity was measured in 129 ST patients presenting with STEMI undergoing immediate PCI. HPR-ADP was observed in 76% of the patients, and HPR on aspirin (HPR-AA) was observed in 13% of the patients. HPR rates were similar in patients who were on maintenance P2Y12 inhibitor or aspirin since stent placement versus those without these medications. In addition, HPR-ADP was similar in patients loaded with a P2Y12 inhibitor shortly before immediate PCI versus those who were not. In contrast, HPR-AA trended to be lower in patients loaded with aspirin as compared with those not loaded.

Conclusions: approximately 3 out of 4 ST patients with STEMI undergoing immediate PCI had HPR-ADP, and 13% had HPR-AA. Whether patients were on maintenance antiplatelet therapy while developing ST or loaded with P2Y12 inhibitors shortly before undergoing immediate PCI had no influence on the HPR rates. This raises concerns that the majority of patients with ST have suboptimal platelet inhibition undergoing immediate PCI.

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Accepted/In Press date: 18 September 2017
e-pub ahead of print date: 18 December 2017
Published date: 26 December 2017
Keywords: Adenosine Diphosphate/blood, Aged, Biomarkers/blood, Blood Platelets/drug effects, Coronary Thrombosis/blood, Drug Resistance, Europe, Female, Humans, Male, Middle Aged, Percutaneous Coronary Intervention/adverse effects, Platelet Aggregation Inhibitors/adverse effects, Platelet Function Tests, Purinergic P2Y Receptor Antagonists/adverse effects, Receptors, Purinergic P2Y12/blood, Recurrence, Registries, Risk Factors, ST Elevation Myocardial Infarction/blood, Stents/adverse effects, Time Factors, Treatment Outcome

Identifiers

Local EPrints ID: 435643
URI: http://eprints.soton.ac.uk/id/eprint/435643
DOI: doi:10.1016/j.jcin.2017.09.019
ISSN: 1936-8798
PURE UUID: 9cb338ee-595b-43e5-b1ce-cd421b8dab0c
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 15 Nov 2019 17:30
Last modified: 17 Mar 2024 03:02

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Contributors

Author: Thea C Godschalk
Author: Robert A Byrne
Author: Tom Adriaenssens
Author: Nikesh Malik
Author: Laurent J Feldman
Author: Giulio Guagliumi
Author: Fernando Alfonso
Author: Franz-Josef Neumann
Author: Dietmar Trenk
Author: Michael Joner
Author: Christian Schulz
Author: Philippe G Steg
Author: Alison H Goodall
Author: Roman Wojdyla
Author: Dariusz Dudek
Author: Joanna J Wykrzykowska
Author: Ota Hlinomaz
Author: Azfar G Zaman
Author: Nick Curzen ORCID iD
Author: Jo Dens
Author: Peter Sinnaeve
Author: Walter Desmet
Author: Anthony H Gershlick
Author: Adnan Kastrati
Author: Steffen Massberg
Author: Jurriën M Ten Berg
Corporate Author: et al.
Corporate Author: PRESTIGE Investigators

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