Clopidogrel pretreatment in primary percutaneous coronary intervention: Prevalence of high on-treatment platelet reactivity and impact on preprocedural patency of the infarct-related artery

José Luis Ferreiro; Sílvia Homs; Javier Berdejo; Gerard Roura; Josep Gómez-Lara; Rafael Romaguera; Luis Teruel; Guillermo Sánchez-Elvira; Ana Lucrecia Marcano; Joan Antoni Gómez-Hospital; Dominick J. Angiolillo; Ángel Cequier

doi:10.1160/TH13-01-0057

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2013; 110(01): 110-117
DOI: 10.1160/TH13-01-0057

Platelets and Blood Cells

Schattauer GmbH

Clopidogrel pretreatment in primary percutaneous coronary intervention: Prevalence of high on-treatment platelet reactivity and impact on preprocedural patency of the infarct-related artery

José Luis Ferreiro^*

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Sílvia Homs^*

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Javier Berdejo

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Gerard Roura

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Josep Gómez-Lara

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Rafael Romaguera

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Luis Teruel

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Guillermo Sánchez-Elvira

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Ana Lucrecia Marcano

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Joan Antoni Gómez-Hospital

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

,

Dominick J. Angiolillo

²University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA

,

Ángel Cequier

¹Heart Diseases Institute, Bellvitge University Hospital – IDIBELL, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

› Institutsangaben

Abstract

Summary

To date, there is limited data on levels of platelet inhibition achieved in patients with ST-elevation myocardial infarction (STEMI) who are loaded with clopidogrel and aspirin (ASA) prior to undergoing primary percutaneous coronary intervention (P-PCI). The aim of this investigation was to evaluate the percentage of STEMI patients with high on-treatment platelet reactivity (HPR) to clopidogrel at the time of initiating P-PCI and its association with the initial patency of the infarct-related artery (IRA). This prospective pharmacodynamic study included 50 STEMI patients, previously naïve to oral antiplatelet agents, who received 500-mg ASA and 600-mg clopidogrel loading doses prior to P-PCI. Platelet function assessment was performed at the beginning of the procedure using various assays, including VerifyNow^™ system (primary endpoint), light transmission aggregometry and multiple electrode aggregometry. The percentage of patients with suboptimal response to clopidogrel and ASA assessed with the VerifyNow^™ system was 88.0% and 28.6%, respectively. Similar results were obtained with the other assays used. A higher percentage of patients with initial patency of the IRA was observed among those patients without HPR compared with those with HPR to clopidogrel (66.7% vs 15.9%; p=0.013), while no differences were observed regarding postprocedural angiographic or electrocardiographic outcomes. In conclusion, this study shows that a high percentage of STEMI patients have inadequate levels of clopidogrel-induced and, to a lesser extent, aspirin-mediated platelet inhibition when starting a P-PCI procedure, and suggests that a poor response to clopidogrel might be associated with impaired initial TIMI flow in the IRA.

Keywords

Clopidogrel responsiveness - ST-elevation myocardial infarction - antiplatelet therapy

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Referenzen

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