The relationship between platelet reactivity and infarct-related artery patency in patients presenting with a ST-elevation myocardial infarction

Breet, Nicoline J.; Werkum, Jochem W. van; Bouman, H. J.; Kelder, Johannes C.; Hackeng, Christian M.; Berg, Jurriën Ten

doi:10.1160/th10-08-0528

Cited by 14 publications

(14 citation statements)

References 29 publications

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“…In the present report, leukocytosis was an independent predictor of impaired platelet inhibition by clopidogrel. Although the relationship evidenced here is likely to be multifactorial, the present data are consistent with previous observations demonstrating the interplay among leukocytosis, fibrinogen and inflammatory status and impaired platelet inhibition by clopidogrel (4,25,31,32). Impaired platelet inhibition by thienopyridines might trigger an inflammatory state.…”

Section: Interplay Between Impaired P2y 12 Inhibition and Inflammatiosupporting

confidence: 92%

The extent of P2Y12 inhibition by clopidogrel in diabetes mellitus patients with acute coronary syndrome is not related to glycaemic control: Roles of white blood cell count and body weight

Morel

Ghannudi²,

Hess³

et al. 2012

Thromb Haemost

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It was the study objective to determine whether glycaemic control affects the extent of platelet inhibition by thienopyridines as assessed by vasodilator-stimulated phosphoprotein flow cytometry (VASP-FCT) in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) during acute coronary syndrome (ACS). Although the proportion of high on-treatment residual platelet reactivity is higher in DM, the contributions of glycaemic control and other factors associated with DM, such as excess body weight and inflammation, to this impaired platelet inhibition by thienopyridines have not yet been fully characterised. In this study, the extent of P2Y12 ADP receptor pathway inhibition was evaluated by the VASP-FCT. Platelet activation was expressed as the platelet reactivity index (PRI). Low response to clopidogrel (LR) was defined as a PRI of >61%. Four hundred forty-five consecutive ACS patients (DM = 160, NDM = 285) were enrolled. The proportion of LR was higher in DM patients (50 vs. 37.5%). In DM, PRI was not correlated with glycosylated haemoglobin (HbA1c) or glycaemia. In a univariate analysis, LR was associated with age, male sex, overweight, and white blood cell count (WBC). In a multivariate analysis, WBC >10,000 and body weight >80 kg were the sole independent predictors of LR to clopidogrel (hazard ratio (HR) 3.02 [1.36-6.68], p=0.006 and HR 2.47 [1.14-5.35], p = 0.021, respectively). Conversely, in non-DM patients, ST-elevation myocardial infarction was the sole independent predictor of LR. In conclusion, in ACS DM patients undergoing PCI, the extent of P2Y12 inhibition by clopidogrel is not related to glycaemic control but is related to body weight and inflammatory status as assessed by the WBC.

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Section: Interplay Between Impaired P2y 12 Inhibition and Inflammatiosupporting

confidence: 92%

The extent of P2Y12 inhibition by clopidogrel in diabetes mellitus patients with acute coronary syndrome is not related to glycaemic control: Roles of white blood cell count and body weight

Morel

Ghannudi²,

Hess³

et al. 2012

Thromb Haemost

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“…17) In addition, other previous studies have shown that various pro-thrombotic and inflammatory markers including the neutrophil to lymphocyte ratio, platelet count and reactivity, mean platelet volume, and uric acid have been associated with the patency of IRA in patients with STEMI before primary PCI. [8][9][10] Although the precise reasons for the difference in the factors of pre-PCI coronary flow between the present study and previous studies are unknown, differences in the cohorts, study definition, and patient backgrounds may have been the causes.…”

Section: Discussionmentioning

confidence: 70%

“…7) Previous studies have shown that various prothrombotic and inflammatory markers including the neutrophil to lymphocyte ratio, platelet count and reactivity, mean platelet volume, and uric acid have been associated with the patency of IRA in patients with STEMI before primary PCI. [8][9][10] However, factors associated with preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow have not been fully investigated. The aim of this study was to examine factors associated with preprocedural TIMI flow in patients with STEMI.…”

Section: Pre-procedural Timi Flow In Stemi Patientsmentioning

confidence: 99%

Pre-Procedural Thrombolysis in Myocardial Infarction Flow in Patients with ST-Segment Elevation Myocardial Infarction

et al. 2018

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It has been shown that the patency of an infarct-related artery (IRA) before primary percutaneous coronary intervention determines post-procedural success, better preservation of left ventricular function, and lower in-hospital mortality. However, the factors associated with pre-procedural Thrombolysis In Myocardial Infarction (TIMI) flow have not been fully investigated.The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective multicenter registry conducted at 28 Japanese medical institutions between July 2012 and March 2014. We enrolled 3,283 consecutive patients with acute myocardial infarction who were admitted to a participating institution within 48 hours of symptom onset. There were 2,262 patients (68.9%) with ST-elevation myocardial infarction (STEMI), among whom 2,182 patients underwent emergent or urgent coronary angiography.Pre-procedural TIMI flow grade 3 was related to post-procedural TIMI flow grade 3 (P < 0.001), lower enzymatic infarct size (P < 0.001), lower ventricular tachycardia and ventricular fibrillation (P = 0.049), and lower in-hospital mortality (P = 0.020). A history of antiplatelet drug use was associated with pre-procedural TIMI flow.Antiplatelet drug use on admission was associated with pre-procedural TIMI flow. The patency of the IRA in patients with STEMI was related to procedural success and decreased enzymatic infarct size, fatal arrhythmic events, and in-hospital mortality.

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“…This is especially important in patients with STEMI because of plaque rupture, high thrombus burden and increased platelet activation [8], [10]. Moreover, there are chronic processes leading to delayed endothelial healing, vessel remodelling and stent malapposition [8], [11].…”

Section: Introductionmentioning

confidence: 99%

Real World Experience of a Biodegradable Polymer Sirolimus-Eluting Stent (Yukon Choice PC Elite) in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty: A Multicentric Observational Study (The Elite India Study)

Verma

Patel²,

Katyal

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: The durable polymer drug-eluting stents (DPDES) reduce the risk of repeated target vessel revascularisation (TLR) compared with BMS, but are associated with increased risk of late adverse events. In broadly inclusive populations, the biodegradable-polymer drug-eluting stents (BPDES) have favourable results compared with DPDES in the long term. However, its use in primary angioplasty has not been adequately studied, and data of real-world clinical experience is lacking. AIM: Aim of this study was to assess the safety and efficacy of Yukon Choice PC Elite sirolimus-eluting stent (a novel BPDES) in STEMI patients undergoing primary angioplasty. METHODS: We have presented here one-year clinical follow-up data of the Yukon Choice PC Elite sirolimus-eluting stent in patients undergoing primary angioplasty. A total of 636 patients were enrolled in this single arm, prospective observational study from five centres. RESULTS: This multicentric observational study showed excellent safety and efficacy profile of the novel device at one year follow up. The device-oriented composite endpoint (DOCE) of cardiac death, target-vessel reinfarction, and target-lesion revascularisation (TLR) was 2.7%, and the patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, and any revascularisation was 4.2% at one year. Definite or probable stent thrombosis rate was 0.6%, and no events were recorded beyond 6 months of follow up. CONCLUSIONS: In patients with STEMI undergoing primary angioplasty, the use of Yukon Choice PC Elite (biodegradable polymer sirolimus-eluting stent) has excellent results at one year. It, therefore, represents an attractive alternative to second generation DES in this high-risk population.

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The relationship between platelet reactivity and infarct-related artery patency in patients presenting with a ST-elevation myocardial infarction

Cited by 14 publications

References 29 publications

The extent of P2Y12 inhibition by clopidogrel in diabetes mellitus patients with acute coronary syndrome is not related to glycaemic control: Roles of white blood cell count and body weight

The extent of P2Y12 inhibition by clopidogrel in diabetes mellitus patients with acute coronary syndrome is not related to glycaemic control: Roles of white blood cell count and body weight

Pre-Procedural Thrombolysis in Myocardial Infarction Flow in Patients with ST-Segment Elevation Myocardial Infarction

Real World Experience of a Biodegradable Polymer Sirolimus-Eluting Stent (Yukon Choice PC Elite) in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty: A Multicentric Observational Study (The Elite India Study)

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