Residual Platelet Reactivity After Clopidogrel Loading in Patients With ST-Elevation Myocardial Infarction Undergoing an Unexpectedly Delayed Primary Percutaneous Coronary Intervention : Impact on Intracoronary Thrombus Burden and Myocardial Perfusion

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Author(s)

    • VAVURANAKIS Manolis
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • VRACHATIS Dimitrios A.
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • PAPAIOANNOU Theodore G.
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • ARCHONTAKIS Stefanos
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • KALOGERAS Konstantinos I.
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • KARIORI Maria G.
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • GAFOU Anthi
    • Transfusion & Haemophilic Center, Hippokration Hospital
    • MOLDOVAN Carmen
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • TZAMALIS Panagiotis
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens
    • STEFANADIS Christodoulos
    • 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens

Abstract

<b><i>Background:</i></b> Residual platelet reactivity (RPR) after clopidogrel loading, measured by the VerifyNow assay, has been shown to predict 12-month clinical events in patients with acute coronary syndromes. However, links between coronary angiographic findings and outcome in patients with ST-elevation myocardial infarction (STEMI), with RPR have not been reported. We investigated whether RPR is associated with the amount of intracoronary thrombus burden (TB) in patients with STEMI undergoing unexpectedly-delayed primary percutaneous coronary intervention (pPCI). Moreover, we evaluated whether RPR might influence coronary flow and myocardial perfusion immediately post-pPCI. <b><i>Methods and Results:</i></b> The VerifyNow assay was used to determine RPR after clopidogrel loading, expressed in P2Y12-Reaction-Units (PRU). Intracoronary-TB was angiographically estimated and stratified as TB-Grade-A, -B and -C. Thrombolysis In Myocardial Infarction (TIMI) flow and Myocardial Blush (MB) were also estimated post-PCI. A total of 74 consecutive patients who presented with STEMI were enrolled in the study. Patients with greater TB presented significantly higher PRU-levels (174.1±91.5, 196.23±113.4 and 252.8±107.8 for TB-Grade A, B and C, respectively; P=0.044). PRU-levels >251.5 were shown to predict Large-TB (LTB; TB-Grade-C) (sensitivity=57.9%; specificity=77.8%; P=0.014). Impaired TIMI-flow and MB after PCI were significantly associated with higher PRU-levels (P<0.001). <b><i>Conclusions:</i></b> Among the studied patients, those with a higher RPR after clopidogrel loading presented larger intracoronary TB, worse post-PCI myocardial flow and perfusion. (<i>Circ J</i> 2011; <b>75:</b> 2105-2112)<br>

Journal

  • Circulation Journal

    Circulation Journal 75(9), 2105-2112, 2011-08-25

    The Japanese Circulation Society

References:  24

Cited by:  5

Codes

  • NII Article ID (NAID)
    10029339351
  • NII NACSIS-CAT ID (NCID)
    AA11591968
  • Text Lang
    ENG
  • Article Type
    Journal Article
  • ISSN
    13469843
  • Data Source
    CJP  CJPref  J-STAGE 
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