P25 Polymorphism of CYP2C19 is associated with poor platelet response to clopidogrel and indirectly affect TIMIi-flow among asian patients with STEMI undergoing primary PCI

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Kemalasari ◽  
R Sukmawan ◽  
S Adiarto
Keyword(s):  
Platelet Reactivity ◽  
Primary Pci ◽  
Platelet Response ◽  
Asian Populations ◽  
Asian Patients ◽  
Timi Flow ◽  
Cyp2c19 Polymorphism ◽  
Cyp2c19 Gene ◽  
Verifynow Assay ◽  
P2y12 Reaction Unit

Abstract Background The platelet response to clopidogrel treatment is very important in patients with myocardial infarction undergoing primary PCI.  Asian populations have been shown to have higher proportion of CYP2C19 gene polymorphism that may alter biotransformation of clopidogrel, than Caucasians. However, It is unclear whether platelet reactivity measured by P2Y12 reaction unit (PRU) is affected by CYP2C19 polymorphism, and whether it will impair coronary flow among Asian patients with STEMI after primary PCI.  Purpose: We sought to define whether polymorphisms on CYP2C19 genes will affect platelet reactivity response to Clopidgrel therapy, and whether subsequently it will affect the TIMI flow in Asian patients with STEMI undergoing primary PCI. Method: We studied 90 patients with STEMI receiving 600 mg loading dose of clopidogrel prior to primary PCI. High-on-treatment platelet reactivity was evaluated using the VerifyNow Assay. Patients with platelet reactivity more than 208 PRU are categorized as non-responders to Clopidogrel. Genotyping of CYP2C19 was performed by real-time polymerase chain reaction (PCR). Post primary PCI TIMI flow was categorized into good (TIMI flow 3), and impaired (TIMI flow <3). Results: Among all 90 patients (median age = 54.5 years old; 93.3% male), there were 36.6 % patients with CYP2C19 polymorhisms, carrying *2 or *3 alleles. Platelet reactivity test revealed 23.4% of all patients were Clopidogrel non-responders. Multivariate analysis showed CYP2C19 polymorphism is associated with Clopidogrel non-reponders (OR 4.7, p = 0.030), along with other factors such as: Diabetes, Renal impairment, and use of proton pump inhibitor drugs. After successful stent implantation during primary PCI,  there were  24.4% patients still with TIMI flow < 3. There was no direct correlation between CYP2C19 polymorphism and TIMI flow < 3 after primary PCI. However, we found significant association between Clopidogrel non-reponders and TMI flow < 3 after primary PCI in those STEMI patients (OR 3.3, p = 0.046). Conclusions: In Asian patients with STEMI receiving clopidogrel prior to primary PCI, the CYP2C19 polymorphisms is associated with poor platelet response to Clopidogrel therapy. The Clopidogrel non-responders is associated with impaired TIMI flow after primary PCI.

Abstract 17577: Searching for the Optimal Regimen of Potent P2Y12 Inhibitor in East Asian Patients with Acute Coronary Syndrome: A Pharmacodynamic Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jang-Young Kim ◽  
Ji Hyun Lee ◽  
Jun-Won Lee ◽  
Young Jin Youn ◽  
Min-Soo Ahn ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Platelet Reactivity ◽  
East Asian ◽  
Coronary Intervention ◽  
Therapeutic Window ◽  
Coronary Syndrome ◽  
Asian Patients ◽  
Verifynow Assay ◽  
Optimal Maintenance ◽  
East Asian Patients

Introduction: The efficacy of prasugrel and ticagrelor has not been well evaluated in East Asian. We sought to compare the pharmacodynamic efficacy of prasugrel and ticagrelor by using VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA). Methods: From 2012 January to 2014 April, we selected 83 patients who were administered ticagrelor 90 mg twice daily (n = 24), prasugrel 10 mg daily (n = 39), or prasugrel 5 mg daily (n = 20) after percutaneous coronary intervention due to acute coronary syndrome in our institute. After 3-4 weeks, on-treatment platelet reactivity (OPR) was measured by VerifyNow assay. According to the previous studies, we used 2 different criteria for the therapeutic window of OPR (East Asian criteria: 275≥PRU>85; Western criteria: 208 ≥PRU>85). We compared the OPR and the proportion of the therapeutic window between 3 groups. Results: The OPR was the lowest in the ticagrelor group, followed by the prasugrel 10 mg and prasugrel 5 mg groups (49.1 ± 29.9 vs. 83.7 ± 57.1 vs. 168.5 ± 60.8, p < 0.001).When we used the East Asian criteria, the prasugrel 5 mg group had the highest proportion of patients in the therapeutic window of OPR followed by prasugrel 10mg and ticagrelor groups ( 90.0% vs. 46.2% vs. 12.5%, p < 0.001). When using Western criteria, the prasugrel 5mg group still showed the highest proportion of patients with therapeutic window followed by prasugrel 10mg and ticagrelor groups (60.0% vs. 43.6% vs. 12.5%, p<0.001). Conclusion: Short-term administration of prasugrel 5mg highly led the patients into the therapeutic window of OPR (in both of East Asian and Western criteria), compared with prasugrel 10mg and ticagrelor 180mg group. The prasugrel 5mg daily might be the optimal maintenance regimen for East Asian patients.

scholarly journals Prasugrel switching from clopidogrel after percutaneous coronary intervention for acute coronary syndrome in Taiwanese patients: an analysis of safety and efficacy

2021 ◽  
Author(s):  
Ping-Yen Liu ◽  
Cheng-Huang Su ◽  
Feng-Yu Kuo ◽  
Wen-Lieng Lee ◽  
Yi-Chih Wang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Maintenance Dose ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Open Label ◽  
Clinical Trial Registration ◽  
Coronary Syndrome ◽  
Asian Populations ◽  
Registration Number ◽  
P2y12 Reaction Unit

AbstractThe recommended maintenance dose of prasugrel for East Asian populations (i.e., Japanese and Taiwanese) is 3.75 mg as part of dual antiplatelet therapy (DAPT) for the prevention of recurrent ischemia and stent thrombosis in acute coronary syndrome (ACS). This modified dosage regimen has been established in studies conducted in Japan; however, the efficacy and safety of switching from clopidogrel to prasugrel DAPT among Taiwanese patients remain to be explored. In this phase IV, multicenter, single-arm, open-label study, we evaluated the 4-week pharmacodynamic response, and the 48-week safety outcomes of prasugrel 3.75 mg after a switch from clopidogrel in Taiwanese ACS patients. A total of 203 prasugrel-naïve ACS patients (over 90% male) who had received post-PCI clopidogrel DAPT for at least 2 weeks were enrolled from ten medical centers in Taiwan and subsequently switched to prasugrel 3.75 mg DAPT. Four weeks after the switch, P2Y12 reaction unit (PRU) values were significantly decreased in the total cohort (mean − 18.2 ± 48.1; 95% confidence interval − 24.9 to − 11.5, p < 0.001), and there was an overall consistent antiplatelet response in the treated subjects. The proportion of patients with high on-treatment platelet reactivity (HPR; PRU > 208) dropped from 23.5 to 10% (p < 0.001). Female sex was associated with a greater PRU reduction with prasugrel, whereas HPR at baseline, age ≥ 65 years, and body mass index ≥ 25 best predicted HPR at Week 4. Throughout the 48-week treatment with prasugrel, the incidences of MACE (1.0%) and TIMI major bleeding (2.0%) were rather low, accompanying an acceptable safety profile of TIMI minor (6.4%) and non-major, non-minor clinically relevant bleeding (3.0%). Overall, switching to the maintenance dose of prasugrel (3.75 mg) was observed to be effective and well tolerated among post-PCI ACS patients in Taiwan. Clinical Trial Registration Number: NCT03672097.

Influence of Amlodipine on Haemostatic Measurements during Clopidogrel Treatment in Patients with Coronary Artery Disease

2019 ◽  
Vol 119 (02) ◽  
pp. 264-273 ◽  
Author(s):  
Jin-Sin Koh ◽  
Yongwhi Park ◽  
Jong-Hwa Ahn ◽  
Min Gyu Kang ◽  
Kye-Hwan Kim ◽  
...  
Keyword(s):  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Fibrin Clot ◽  
Open Label ◽  
Clot Strength ◽  
Asian Patients ◽  
Verifynow Assay ◽  
Risk Patients ◽  
Artery Disease

AbstractAmlodipine has a potential to reduce clopidogrel bioactivation through the cytochrome P450 3A4 enzyme in vivo, but the clinical impact of this interaction remains controversial. This randomized, open-label, two-period, crossover study was performed to evaluate the influence of amlodipine on the haemostatic profiles of high-risk patients during clopidogrel treatment. We recruited 40 Asian patients (Male/Female: n = 36/4) receiving clopidogrel (75 mg/day), aspirin (100 mg/day) and rosuvastatin for at least 6 months following percutaneous coronary intervention. Patients were randomly assigned to receive either 5 mg daily amlodipine or not for 2 weeks, and then were crossed over to the other treatment for 2 weeks. Haemostatic measurements were conducted with the VerifyNow assay and thromboelastography (TEG). Primary endpoint was P2Y12 Reaction Units (PRU) during on- versus off-amlodipine treatment. The on-amlodipine strategy showed higher level of PRU compared with the off-amlodipine strategy (176.8 ± 75.4 vs. 150.7 ± 65.5 PRU; ∆mean: 26.1 PRU; ∆95% confidence interval [CI]: 4.5–47.7 PRU; p = 0.019). Platelet-fibrin clot strength measured by TEG was lower during on- versus off-amlodipine treatment (7,712 ± 1,889 vs. 8,559 ± 2,174 dyne/cm2; ∆mean: –847 dyne/cm2; ∆95% CI: –1,632 to –62 dyne/cm2; p = 0.035). After amlodipine discontinuation, 27 patients (67.5%) showed a decrease in PRU, which was associated with ‘PRU ≥ 160 on-amlodipine’ in multivariate analysis (odds ratio: 62.014; 95% CI: 2.302–1670.328; p = 0.014). In conclusion, amlodipine increases platelet reactivity and decreases platelet-fibrin clot strength during clopidogrel treatment. In addition, the effect of amlodipine discontinuation on clopidogrel responsiveness is associated with on-amlodipine platelet reactivity.

scholarly journals Genetic polymorphism of the CYP2C19 gene in the Foshan area of Guangdong Province

2020 ◽  
Author(s):  
Xiao wen yuan ◽  
Shi-yun Yuan ◽  
Quan Qiu ◽  
Zi-yuan Luo ◽  
Xue-feng Zhao
Keyword(s):  
Guangdong Province ◽  
Cyp2c19 Genotype ◽  
Allele Distribution ◽  
Asian Populations ◽  
Cyp2c19 Polymorphism ◽  
Genotype Frequencies ◽  
Cyp2c19 Gene ◽  
Different Populations

Abstract Background: The CYP2C19 gene is highly polymorphic, and CYP2C19 is involved in the broad interindividual variability of the clinical efficacy of certain clinical medications, such as clopidogrel. However, data on the CYP2C19 genotype in the Chinese population of the Foshan area of Guangdong Province are scarce. The purpose of this study was to determine CYP2C19 genetic polymorphisms in patients in the Foshan area and to compare the CYP2C19 genotype frequencies in different populations to determine the allele distribution pattern to identify the most appropriate prescription. Methods: The CYP2C19 gene was detected in 1231 patients on a gene chip platform, and the genotype frequencies of CYP2C19 in Foshan populations from different populations were compared. Results: The frequencies of CYP2C19*1, *2 and *3 in the Foshan population were 63.89%, 30.46% and 5.65%, respectively. For the three metabolic types, the frequency associated with the rapid metabolism type (*1/*1) was 41.51 [95% confidence interval (CI) 40.11 to 42.91%]; that for the intermediate metabolism type (*1/*2, *1/*3) was 44.76% (95% CI 43.34 to 46.18and that for the slow metabolism type (*2/*2, *2/*3, *3/*3) was 13.73% (95% CI 12.75 to 14.71%). In the Foshan population, the frequencies of the CYP2C19 *2 and *3 alleles were similar to those previously reported for Chinese and other Asian populations. Conclusion: Our study the genetic basis of CYP2C19 polymorphism in the Foshan population. Our results will potentially contribute to the improvement of pharmacotherapy effectiveness by providing personalized medicine for the Foshan population. Key words: Polymorphism; Genetic; Pharmacogenetics

Abstract 339: Comparison of the Antiplatelet Effect Between Ticagrelor and Clopidogrel in Chinese Patients with Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Jingjing Xu ◽  
Yi Yao ◽  
Jiahui Zhang ◽  
Xiaofang Tang ◽  
Yuanliang Ma ◽  
...  
Keyword(s):  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
Target Lesion ◽  
Target Lesion Revascularization ◽  
Chinese Patients ◽  
Primary Pci ◽  
Platelet Response ◽  
Antiplatelet Effect ◽  
Clinical Events

Background: Ticagrelor can provide effective platelet inhibition 2 hours after a loading dose, but it will take 6 hours for clopidogrel. It is not very clear whether the anthplatelet agents treated patients with AMI undergoing primary PCI can achieve ideal antiplatelet effect after 24 to 48 hours. Purpose: The aim is to compare the antiplatelet action between ticagrelor and clopidogrel in Chinese patients with AMI after primary PCI. Methods: 189 patients with AMI after primary PCI were enrolled in this single center registry. All patients received loading and maintenance dose of dual antiplatelet therapy (aspirin+clopidogrel/ticagrelor). 58 cases were included in ticagrelor group. 131 patients were included in clopidogrel group. Residual platelet reactivity was assessed by VerifyNow 24-48 hours after PCI. All patients were followed-up for 30 days and 6 months after discharge. Results: The baseline data were well matched between the two groups. After 24-48 hours, 51 cases existed of high residual platelet response(HRPR)(platelet response unit ,PRU≥230), the ratio was 26.98%. In clopidogrel group, the average PRU was 195.8 (26~329), and 43 patients existed HRPR, ratio was 32.82%. For ticagrelor group, the average PRU was 101.8 (6~322), and 8 patients existed HRPR, ratio was 14.04%. The incidence of HRPR was significantly lower in ticagrelor group ( p < 0.0001). Within 30 days, the incidence of MI in clopidogrel group and ticagrelor group were respectively 0.8% and 0, p =0.693; target lesion revascularization were 1.7% and 1.5%, p =0.669; death were 0.8% and 0, p =0.693; stroke were 0 and 0, p =1.000; bleeding were 2.3% and 0, p =0.331. In 6 months, the incidence of MI were 0.8% and 0, p =0.693; target lesion revascularization were 0.8% and 0, p =0.693; death were 0 and 0, p =1.000. The incidence of MACE, bleeding and stroke had no obvious difference between the two groups. Conclusion: 24 hours after primary PCI, there are still a large proportion of Chinese patients with AMI existing insufficient platelet inhibition, no matter they take clopidogrel or ticagrelor, but ticagrelor has a significant stronger antiplatelet effect than clopidogrel. There is no obvious difference between the incidences of clinical events.

scholarly journals PHARMACOGENETIC BASES OF INDIVIDUAL SENSITIVITY AND PERSONALIZED ADMINISTRATION OF ANTIPLATELET THERAPY IN DIFFERENT ETHNIC GROUPS

2021 ◽  
Vol 8 (6) ◽  
pp. 392-404
Author(s):  
B. I. Kantemirova ◽  
E. A. Orlova ◽  
O. S. Polunina ◽  
E. N. Chernysheva ◽  
M. A. Abdullaev ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Ethnic Groups ◽  
Ethnic Diversity ◽  
Trigger Point ◽  
Platelet Reactivity ◽  
Antiplatelet Agents ◽  
Antiplatelet Drugs ◽  
Cyp2c19 Polymorphism ◽  
Cyp2c19 Gene ◽  
Methodological Approaches

Cardiovascular diseases (CVDs) are the leading cause of disability and mortality worldwide. Increased thrombosis is the trigger point for the development of various CVDs and their complications, and therefore, therapy with P2Y12-receptor inhibitors is always pathogenetically justified and vital. However, according to the various data, 10-25% of patients treated with clopidogrel have “resistance” to antiplatelet therapy. The causes for the formation of resistance are still not clear. There is no generally accepted, standard methodology for determining resistance to antiplatelet agents. In addition, there are no methodological approaches to identify the patients with resistance to antiplatelet drugs, and standardized schemes for correcting a low sensitivity to these drugs.The aim of this review was to summarize the available results of foreign and domestic studies devoted to the investigation of the effectiveness and safety problems of antiplatelet drugs administration from the point of view of the genetic predisposition to changes in their metabolism.Materials and methods. For the review, the following information from scientific literature represented in open and accessible sources for the period of 1996-2020, was used: pharmgkb.org, PubMed, Scopus, Web of Science Core Collection, Elibrary. Search queries – “Genetic features+antiplatelet therapy+ethnic groups”, “CYP2C19+clopidogrel+antiplatelet therapy effectiveness”; “Stent retrombosis+CYP2C19 polymorphism+ residual platelet reactivity” and “CYP2C19 polymorphism+ethnic groups+clopidogrel resistance” in both Russian and English equivalents. All these data are placed in electronic databases.Results. Currently, the problem of the resistance formation to antiplatelet drugs is studied insufficiently. The best thought-out issue is the research of the effect of the polymorphic alleles carriage of the CYP2C19 gene on the residual platelet reactivity in the patients administrated with dual antiplatelet treatment, including clopidogrel. In general, the analysis of open literature sources indicates the presence of a statistically significant association between the carrier of slow alleles of the CYP2C19 gene and the residual platelet reactivity, clinically manifested by thrombosis and adverse cardiovascular events. The occurrence frequency of polymorphic carriage of the CYP2C19 gene varies in different ethnic groups, so it cannot be extrapolated to individual subjects, peculiar in the ethnic diversity.Conclusion. To develop preventive and predictive measures aimed at overcoming resistance to antiplatelet agents, as well as working out methodological approaches to personalized prescribtion of this group drugs, a further investigation with the expansion of the search for causes and the study of the other genes participation of the cytochrome P450 system, is required.

scholarly journals Use of Thromboelastography Platelet Mapping for Assessment of Individual Platelet Response Secondary to Oral Antiplatelet Therapy after Percutaneous Coronary Intervention: An Attempt to Start Personalized Antiplatelet Therapy in India

2021 ◽  
Author(s):  
Suvro Sankha Datta ◽  
Dibyendu De ◽  
Nadeem Afroz Muslim
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Antiplatelet Therapy ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Platelet Inhibition ◽  
P Value ◽  
Platelet Response ◽  
Percutaneous Coronary ◽  
The Individual ◽  
Platelet Functions

AbstractHigh on-treatment platelet reactivity (HPR) with P2Y12 receptor antagonists in patients treated with dual antiplatelet therapy (DAPT) is strongly associated with adverse ischemic events after percutaneous coronary intervention (PCI). This prospective study was conducted to assess individual platelet response and HPR to antiplatelet medications in post-PCI cases by thromboelastography platelet mapping (TEG-PM). Total 82 patients who were on aspirin and on either clopidogrel, prasugrel, or ticagrelor were evaluated. The percentage of platelet inhibition to arachidonic acid (AA) and adenosine disdiphosphate (ADP) was calculated by [100-{(MA ADP/AA–MA Fibrin) / (MA Thrombin–MA Fibrin) × 100}], taking 50% response as cut-off for HPR. HPR to clopidogrel and prasugrel was 14.29 and 12.5%, respectively. No HPR was detected to aspirin and ticagrelor. The mean percentage of platelet inhibition was significantly higher in patients with ticagrelor 82.99, 95% confidence interval (CI) of [77.3, 88.7] as compared with clopidogrel 72.21, 95% CI of [65.3, 79.1] and prasugrel 64.2, 95% CI of [52.5, 75.9] (p-value of 0.041 and 0.003, respectively). Aspirin along with ticagrelor is associated with a higher mean percentage of platelet inhibition, and lower HPR as compared with the usage of aspirin combined with clopidogrel or prasugrel. Additionally, it might also be concluded that TEG-PM could be used effectively to measure the individual platelet functions which would make oral antiplatelet therapy more personalized for cardiac patients.

scholarly journals Long-term complications after stent assist coiling dependent on clopidogrel response

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kenji Shoda ◽  
Yukiko Enomoto ◽  
Yusuke Egashira ◽  
Takamasa Kinoshita ◽  
Daisuke Mizutani ◽  
...  
Keyword(s):  
Acute Phase ◽  
Platelet Reactivity ◽  
Unruptured Aneurysms ◽  
Hemorrhagic Events ◽  
Before And After ◽  
Verifynow Assay ◽  
Previously Treated ◽  
The Relationship ◽  
Delayed Phase

Abstract Background Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications. Methods Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter). Results From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p <  0.01). Thrombotic events were not significantly different between the two groups. Conclusion Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.

scholarly journals Pyoderma Gangrenosum and Erythema Nodosum Revealing Takayasu’s Arteritis

2016 ◽  
Vol 8 (3) ◽  
pp. 354-357 ◽  
Author(s):  
Jonas Loetscher ◽  
Susanna Fistarol ◽  
Ulrich A. Walker
Keyword(s):  
Pyoderma Gangrenosum ◽  
Erythema Nodosum ◽  
Takayasu’S Arteritis ◽  
Skin Lesions ◽  
Takayasu's Arteritis ◽  
Young Females ◽  
Worldwide Distribution ◽  
Asian Populations ◽  
Asian Patients ◽  
Caucasian Female

We report a Caucasian female who presented with simultaneous erythema nodosum and pyoderma gangrenosum due to underlying Takayasu’s arteritis. Takayasu’s arteritis is a chronic large vessel vasculitis of unknown cause. The disease has a worldwide distribution but is most commonly seen in Asian populations. There is a strong predilection for young females. The clinical presentation is variable, but mostly derives from stenosis or occlusion of affected arteries, resulting in claudication and ischemia. Skin manifestations are observed in up to 28% of patients with Takayasu’s arteritis, with erythema nodosum reported more frequently in Caucasians. Pyoderma gangrenosum is more common in Asian patients. This report demonstrates the importance to exclude Takayasu’s arteritis in patients with such skin lesions.

Effect of high dose statin preloading on TIMI flow in patients presenting with ST-Elevation Myocardial Infarction undergoing Primary Percutaneous Coronary Intervention

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
K Eletriby ◽  
A Desoky ◽  
N Shawky ◽  
A Farag
Keyword(s):  
Myocardial Infarction ◽  
High Intensity ◽  
Coronary Intervention ◽  
Control Group ◽  
P Value ◽  
Primary Pci ◽  
Timi Flow ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Aim and objectives The aim of this study was to assess the impact of high intensity statins used prior to primary PCI in patients presenting with acute STEMI (ST-elevation Myocardial Infarction) on myocardial perfusion and in-hospital MACE (major adverse cardiac events). Patients and Methods The study included 170 patients who presented with acute STEMI to the cardiology department of Ain Shams university hospitals and underwent primary PCI (percutaneous coronary intervention). They were divided into two groups where the first group received high intensity statins (40-80mg of atorvastatin or 20-40mg of rosuvastatin) besides guideline recommended therapy before primary PCI and the 2nd group served as a control group and received guideline recommended therapy, and high intensity statins after going back to the coronary care unit after primary PCI. Post interventional thrombolysis in myocardial infarction (TIMI) flow grade and myocardial blush grade (MBG) were recorded and ST-segment resolution was measured. Results The majority of patients in both groups had the LAD as the culprit vessel for their presentation. In the control group there were 4 patients with TIMI I flow and MBG I, 13 with TIMI II flow and MBG II and 68 with TIMI III flow and MBG III. Meanwhile in the cases group there was 1 patient with TIMI I flow and MBG I, 3 with TIMI II flow and MBG II and 81 with TIMI III flow and MBG III. This difference was statistically significant with a P value of 0.010. There were 34 patients in the cases group who showed complete ST-segment resolution (40%) vs 19 patients (22.4%) in the control group which was statistically significant with a P value of 0.013. In addition, ejection fraction measured by M-mode had values of Mean+-SD of 45.91 ± 5.49 in cases group vs 43.01 ± 8.80 in control group which was statistically significant with a P value of 0.011. There was not a statistically significant difference between the two groups regarding in-hospital death of all causes and stroke after primary PCI. Conclusion High intensity statin loading before primary PCI resulted in improved post-procedural TIMI flow, MBG, complete ST-segment resolution and ejection fraction as measured by M-mode but did not decrease incidence of in-hospital MACE.

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