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

2011 ◽  
Vol 106 (08) ◽  
pp. 331-336 ◽  
Author(s):  
Nicoline J. Breet ◽  
Jochem W. van Werkum ◽  
Heleen J. Bouman ◽  
Johannes C. Kelder ◽  
Christian M. Hackeng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Reactivity ◽  
St Elevation Myocardial Infarction ◽  
Light Transmittance ◽  
Timi Flow ◽  
Light Transmittance Aggregometry ◽  
Infarct Related Artery ◽  
Leukocyte Counts ◽  
St Elevation ◽  
The Relationship

SummaryBoth heightened platelet reactivity and an occluded infarct related artery (IRA) on initial angiography and at the time of primary percutaneous coronary intervention (PCI) are associated with a worsened clinical outcome in patients with ST-elevation myocardial infarction (STEMI). However, the relationship between platelet reactivity and IRA patency has not yet been established. Consecutive STEMI-patients were enrolled in this study. Patients who had TIMI-flow (thrombolysis in myocardial infarction) 0 or 1 on initial angiography constituted the occluded IRA group and patients having TIMI-flow 2 or 3 comprised the IRA patent group. Platelet function measurements were performed using the PFA-100 COL/ADP cartridge and light transmittance aggregometry without agonist (spontaneous) and after stimulation with adenosine diphosphate (ADP) and arachidonic acid (AA). Ninety-nine patients were enrolled, of whom 49 presented with an occluded IRA. Multivariate analysis identified the following independent factors to be associated with an occluded IRA; short COL/ADP closure time (ORper quartile increase= 0.60; 95% CI, 0.39-.93; p=0.02), the 20 μM ADP-induced light transmittance aggregometry (ORper quartile increase =1.77; 95% CI, 1.15–l2.73; p=0.01) and leukocyte counts (odds ratio [OR]=1.21; 95% CI, 1.05–1.39; p = 0.008). In conclusion, heightened platelet reactivity and elevated leukocyte counts are associated with an occluded IRA upon presentation in STEMI-patients. These results emphasise the importance of potent antithrombotic therapy early after the onset of symptoms, to obtain early recanalisation of the IRA.

scholarly journals Point of Care Tests VerifyNow P2Y12 and INNOVANCE PFA P2Y Compared to Light Transmittance Aggregometry After Fibrinolysis

2018 ◽  
Vol 24 (7) ◽  
pp. 1109-1116 ◽  
Author(s):  
Vincent Roule ◽  
Pierre Ardouin ◽  
Yohan Repessé ◽  
Agnès Le Querrec ◽  
Katrien Blanchart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Platelet Reactivity ◽  
Point Of Care ◽  
Light Transmittance ◽  
Light Transmittance Aggregometry ◽  
St Elevation ◽  
Point Of Care Tests

Detection of high on-treatment platelet reactivity (HPR) by point-of-care tests has not been validated after successful fibrinolysis for ST-elevation myocardial infarction. We assessed the validity of the point-of-care VerifyNow P2Y12 (VN) and INNOVANCE PFA P2Y (PFA) tests on HPR compared to light transmittance aggregometry (LTA) in these patients. The HPR was identified in 10 (34.5%) patients, 15 (51.7%) patients, and 14 (50%) patients using LTA, VN, and PFA, respectively. Discrepancies were observed between the tests despite significant correlations between platelet reactivity measures by LTA and VN ( r = 0.74; P < .0001) and LTA and PFA ( r = .75; P < .0001). Compared to LTA, VN and PFA were associated with a 92% and 53% and 92% and 64% positive predictive value (PPV) and negative predictive value (NPV), respectively, in detecting HPR. When combined, VN and PFA results yielded 90% and 100% PPV and NPV values if discrepancies between the 2 tests were considered as non-HPR. The VN or PFA identify patients without HPR correctly but overestimate the proportion of HPR patients. The association of the 2 tests, in case of HPR, improves the accuracy of the detection of HPR.

scholarly journals The Relationship between Admission HbA1c Level and Infarct-Related Artery Patency in ST Elevation Myocardial Infarction Patients

2019 ◽  
Vol 25 (4) ◽  
pp. 304-311
Author(s):  
Muhammet Cihat Celik ◽  
◽  
Abdullah Nabi Aslan ◽  
Ahmet Korkmaz ◽  
Murat Can Guney ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hba1c Level ◽  
St Elevation Myocardial Infarction ◽  
Infarct Related Artery ◽  
St Elevation ◽  
The Relationship

scholarly journals THE EFFECT OF PLATELET REACTIVITY ON INFARCT RELATED ARTERY PATENCY IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

2010 ◽  
Vol 55 (10) ◽  
pp. A187.E1754
Author(s):  
Nicoline J. Breet ◽  
Carina ACM Pittens ◽  
Heleen J. Bouman ◽  
Jochem W. van Werkum ◽  
Jurrien M. ten Berg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Reactivity ◽  
St Elevation Myocardial Infarction ◽  
Infarct Related Artery ◽  
St Elevation

Abstract 346: Platelet Reactivity to Aspirin and Clopidogrel in Patients with Acute ST Elevation Myocardial Infarction and its Correlation with High Sensitivity C- Reactive Protein

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Archana Rajdev ◽  
Oana Penciu ◽  
Jacqueline Bradley ◽  
Cristina Mihu ◽  
Alan Siqueros ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Reactivity ◽  
High Sensitivity ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
St Elevation ◽  
Hs Crp

INTRODUCTION Implantation of bare metal or drug eluting stents supported by dual antiplatelet therapy (DAPT) is standard treatment for the management of patients with ST elevation myocardial infarction (STEMI). Individual response to aspirin and clopidogrel is heterogeneous, and decreased response is associated with thrombotic events following stenting. We postulated that systemic inflammation at the time of STEMI would diminish responsiveness to DAPT. The aim of this study is to evaluate the correlation between elevated high-sensitivity C-reactive protein (hs-CRP) as a marker of inflammation and decreased platelet sensitivity to DAPT in STEMI. METHODS We recruited patients with STEMI undergoing percutaneous coronary intervention (PCI) who received oral clopidogrel 600 mg loading dose followed by 75 mg daily maintenance dose and aspirin 325 mg daily. Platelet reactivity and hs-CRP were measured within 72 hours of PCI and at 6 weeks. For patients receiving eptifibatide, blood samples were taken 48 hours after discontinuation. Platelet reactivity was assessed using the VerifyNow platelet function analyzer. A cut-off value of 208 platelet reaction units (PRU) was used to define high on-clopidogrel platelet reactivity (HCPR) and a value of 454 aspirin reaction units (ARU) was used to define high on-aspirin platelet reactivity (HAPR). RESULTS In 20 patients aged 31 to 85, in hospital and 6 weeks after STEMI, hs-CRP was 6.7 (SD 4.0) and 2.6 (SD 3.2) respectively, p< 0.01. Changes in ARU from 408.3 (SD 54.3) to 425.2 (SD 68.2) and PRU from 157.8 (SD 74.7) to 164.2 (SD 75) were not statistically significant. 2 patients had HAPR in hospital; 1 became sensitive at follow up. 2 patients developed HAPR and HCPR. We saw a trend towards higher PRU in diabetic patients and those prescribed statins. CONCLUSIONS Although we found a significant difference in hs-CRP levels between the first and second time point, no significant difference was found in on-aspirin and on-clopidogrel platelet reactivity between the time points.Thus, in this small series, the acute inflammatory state associated with STEMI did not appear to influence the on-DAPT reactivity at the dosages used. Trends among those with diabetics and prescribed statins will be discussed

Abstract 14004: Pharmacodynamic Profiles of Ticagrelor in Patients With ST-Elevation Myocardial Infarction: A Prospective Randomized Comparison of Escalating Loading Dose Regimens

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Francesco Franchi ◽  
Fabiana Rollini ◽  
Jung Rae Cho ◽  
Mona Bhatti ◽  
Christopher DeGroat ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Time Course ◽  
Peak Plasma ◽  
Platelet Reactivity ◽  
Randomized Study ◽  
Plasma Concentrations ◽  
St Elevation Myocardial Infarction ◽  
Reactivity Index ◽  
Loading Dose ◽  
St Elevation

Background: Pharmacodynamic (PD) studies have shown that in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI), ticagrelor is associated with suboptimal platelet inhibition and elevated rates of high on-treatment platelet reactivity (HPR) in the early hours after loading dose (LD) administration. Impaired absorption affecting drug pharmacokinetics (PK) has been hypothesized as a contributing factor suggesting increasing LD regimens to improve PK/PD profiles. To date there are no randomized studies which have investigated the PK/PD effects of escalating ticagrelor LD regimens in patients undergoing PPCI. Methods: In this prospective, randomized study, STEMI patients undergoing PPCI (n=52) were randomized 1:1:1 to receive 180mg, 270mg or 360mg LD of ticagrelor. PK and PD analysis were performed before and at 6 time points after LD. PD assessments included P2Y 12 reaction units (PRU) measured by VerifyNow P2Y12 and platelet reactivity index (PRI) measured by VASP. PK assessments included plasma concentrations of ticagrelor and its metabolite AR-C124910XX. Results: At baseline there were no differences in platelet reactivity between groups. At 2 hrs (primary endpoint), there were no differences in PRU between groups (p=0.54). There were no differences in PRU between groups during the overall study time course (p=0.17; Figure). Accordingly, HPR (PRU>208) at 2 hrs was observed in 30% of patients and was not reduced by escalating ticagrelor LD regimens. Consistent PD findings were observed with VASP-PRI. PK data tracked PD results, with a non-dose related delay in peak plasma concentrations of both ticagrelor and AR-C124910XX, particularly in HPR patients. Conclusions: In STEMI patients undergoing PPCI, increasing the LD regimen of ticagrelor did not translate into more prompt or potent P2Y 12 inhibition, which is attributed to impaired absorption in the early hours after drug administration.

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