European Heart Journal: Acute Cardiovascular Care 2016, Vol. 5(5) 475–486 © The European Society of Cardiology 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2048872615624849 acc.sagepub.com EUROPEAN SOCIETY OF CARDIOLOGY ® Introduction Primary percutaneous coronary intervention (PPCI) is the recommended method of coronary reperfusion in patients with ST-segment elevation myocardial infarction (STEMI). 1,2 Given the pivotal pathophysiologic role of activated platelets in thrombotic coronary artery occlusion, dual-antiplatelet therapy (DAPT), consisting of aspirin plus an oral adenosine diphosphate (ADP) receptor (P2Y 12 ) Impact of residual platelet reactivity on reperfusion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention Piera Capranzano 1 , Davide Capodanno 1 , Chiara Bucciarelli-Ducci 2 , Giuseppe Gargiulo 1 , Claudia Tamburino 1 , Bruno Francaviglia 1 , Yohei Ohno 1 , Alessio La Manna 1 , Salemi Antonella 1 , Guilherme F Attizzani 1 , Dominick J Angiolillo 3 and Corrado Tamburino 1 Abstract Aim: Whether high platelet reactivity (HPR) immediately after diagnostic angiography is associated with worse coronary reperfusion prior to and after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is unknown. This study aimed to assess the impact of P2Y 12 -mediated HPR on angiographic outcomes in patients with STEMI undergoing PPCI. Methods: STEMI patients undergoing PPCI and pretreated with a P2Y 12 receptor antagonist underwent platelet function testing with the VerifyNow™ assay at the time of angiography. Light transmission aggregometry (LTA) was performed in a subgroup. HPR was defined according to expert consensus definitions. Pre-PCI coronary patency, thrombotic burden and indices of impaired post-PCI reperfusion were compared between HPR and non-HPR patients. Results: Among 164 patients, the prevalence of VerifyNow™-derived HPR was 71.3% at a median (interquartile range (IQR)) of 55 (40–75) minutes after a P2Y 12 inhibitor loading dose. Compared with non-HPR patients, those with HPR had significantly lower rates of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grades 2 or 3 (51.1% vs. 32.5%, p = 0.04), higher rates of thrombus score (TS) grade 3/4 (29.8% vs. 52.1%, p = 0.015) and 4 (14.9% vs. 32.5%, p = 0.037) and lower median (IQR) corrected TIMI frame count (cTFC; 23.2 (15.8–32.5) vs. 26.0 (21.0–35.0), p = 0.02), respectively. These findings were consistent using LTA-based data. HPR and TS grade 4 were predictors of higher cTFC. Conclusions: In patients with STEMI undergoing PPCI pretreated with P2Y 12 receptor inhibitors, pre-PPCI HPR was found to be associated with lower pre-PCI coronary patency, higher thrombotic burden and a worse index of post-PCI coronary reperfusion. Keywords Platelet reactivity, ST-elevation myocardial infarction, percutaneous coronary intervention Received: 16 July 2015; accepted: 9 December 2015; Disposition: 9 December 2015 1 Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy 2 Bristol Heart Institute, Bristol NIHR Cardiovascular Biomedical Research Unit, University of Bristol, UK 3 University of Florida College of Medicine, Jacksonville, FL, USA Corresponding author: Davide Capodanno, University of Catania, Cardiovascular Department- Ferrarotto, Citelli 6, 95124 Catania, Italy. Email: dcapodanno@gmail.com 624849ACC 0 0 10.1177/2048872615624849European Heart Journal: Acute Cardiovascular CareCapranzano et al. research-article 2016 Original scientific paper Downloaded from https://academic.oup.com/ehjacc/article/5/5/475/5922220 by guest on 01 January 2023