Skip to main content
SpringerLink
Log in

Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre-hospital fibrinolysis compared to primary PCI

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

We compared residual platelet reactivity and post PCI atherothrombotic burden using OFDI in patients successfully treated by primary PCI versus pharmacoinvasive approach (PI) defined as PCI after successful pre-hospital fibrinolysis. Despite pre-hospital P2Y12-inhibitor loading dose, high rates of high on-treatment platelet reactivity were found at the time of PCI in both groups. Primary PCI patients had higher post stenting thrombus burden and lower rates of final normal myocardial blush grade compared to PI. These findings support the use of a pharmacoinvasive reperfusion strategy especially when primary PCI cannot be timely performed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

References

  1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimsky P (2018) 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39(2):119–177. https://doi.org/10.1093/eurheartj/ehx393

    Article  PubMed  Google Scholar 

  2. Armstrong PW, Boden WE (2011) Reperfusion paradox in ST-segment elevation myocardial infarction. Ann Intern Med 155(6):389–391. https://doi.org/10.7326/0003-4819-155-6-201109200-00008

    Article  PubMed  Google Scholar 

  3. Roule V, Ardouin P, Blanchart K, Lemaitre A, Wain-Hobson J, Legallois D, Alexandre J, Sabatier R, Milliez P, Beygui F (2016) Prehospital fibrinolysis versus primary percutaneous coronary intervention in ST-elevation myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Critic Care 20(1):359. https://doi.org/10.1186/s13054-016-1530-z

    Article  Google Scholar 

  4. Ruggeri ZM (2002) Platelets in atherothrombosis. Nat Med 8(11):1227–1234. https://doi.org/10.1038/nm1102-1227

    Article  CAS  PubMed  Google Scholar 

  5. Althoff TF, Fischer M, Langer E, Ziemer S, Baumann G (2010) Sustained enhancement of residual platelet reactivity after coronary stenting in patients with myocardial infarction compared to elective patients. Thromb Res 125(5):e190–196. https://doi.org/10.1016/j.thromres.2010.01.003

    Article  CAS  PubMed  Google Scholar 

  6. Geisler T, Kapp M, Gohring-Frischholz K, Daub K, Dosch C, Bigalke B, Langer H, Herdeg C, Gawaz M (2008) Residual platelet activity is increased in clopidogrel- and ASA-treated patients with coronary stenting for acute coronary syndromes compared with stable coronary artery disease. Heart 94(6):743–747. https://doi.org/10.1136/hrt.2006.100891

    Article  CAS  PubMed  Google Scholar 

  7. Diego A, de Prado AP, Cuellas C, de Miguel A, Samaniego B, Alonso-Rodriguez D, Bangueses R, Vega B, Martin J, Fernandez-Vazquez F (2012) P2Y12 platelet reactivity after thrombolytic therapy for ST-segment elevation myocardial infarction. Thromb Res 130(3):e31–36. https://doi.org/10.1016/j.thromres.2012.05.031

    Article  CAS  PubMed  Google Scholar 

  8. Price MJ, Angiolillo DJ, Teirstein PS, Lillie E, Manoukian SV, Berger PB, Tanguay JF, Cannon CP, Topol EJ (2011) Platelet reactivity and cardiovascular outcomes after percutaneous coronary intervention: a time-dependent analysis of the Gauging Responsiveness with a VerifyNow P2Y12 assay: Impact on Thrombosis and Safety (GRAVITAS) trial. Circulation 124(10):1132–1137. https://doi.org/10.1161/circulationaha.111.029165

    Article  PubMed  Google Scholar 

  9. Stone GW, Witzenbichler B, Weisz G, Rinaldi MJ, Neumann FJ, Metzger DC, Henry TD, Cox DA, Duffy PL, Mazzaferri E, Gurbel PA, Xu K, Parise H, Kirtane AJ, Brodie BR, Mehran R, Stuckey TD (2013) Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet 382(9892):614–623. https://doi.org/10.1016/s0140-6736(13)61170-8

    Article  PubMed  Google Scholar 

  10. Storey RF, Angiolillo DJ, Patil SB, Desai B, Ecob R, Husted S, Emanuelsson H, Cannon CP, Becker RC, Wallentin L (2010) Inhibitory effects of ticagrelor compared with clopidogrel on platelet function in patients with acute coronary syndromes: the PLATO (PLATelet inhibition and patient Outcomes) PLATELET substudy. J Am Coll Cardiol 56(18):1456–1462. https://doi.org/10.1016/j.jacc.2010.03.100

    Article  CAS  PubMed  Google Scholar 

  11. Montalescot G, Sideris G, Meuleman C, Bal-dit-Sollier C, Lellouche N, Steg PG, Slama M, Milleron O, Collet JP, Henry P, Beygui F, Drouet L (2006) A randomized comparison of high clopidogrel loading doses in patients with non-ST-segment elevation acute coronary syndromes: the ALBION (Assessment of the best loading dose of clopidogrel to blunt platelet activation, inflammation and ongoing necrosis) trial. J Am Coll Cardiol 48(5):931–938. https://doi.org/10.1016/j.jacc.2006.04.090

    Article  CAS  PubMed  Google Scholar 

  12. Parodi G, Valenti R, Bellandi B, Migliorini A, Marcucci R, Comito V, Carrabba N, Santini A, Gensini GF, Abbate R, Antoniucci D (2013) Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol 61(15):1601–1606. https://doi.org/10.1016/j.jacc.2013.01.024

    Article  CAS  PubMed  Google Scholar 

  13. Rasmanis G, Vesterqvist O, Green K, Edhag O, Henriksson P (1992) Evidence of increased platelet activation after thrombolysis in patients with acute myocardial infarction. Br Heart J 68(4):374–376

    Article  CAS  Google Scholar 

  14. Kubo T, Imanishi T, Takarada S, Kuroi A, Ueno S, Yamano T, Tanimoto T, Matsuo Y, Masho T, Kitabata H, Tsuda K, Tomobuchi Y, Akasaka T (2007) Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J Am Coll Cardiol 50(10):933–939. https://doi.org/10.1016/j.jacc.2007.04.082

    Article  PubMed  Google Scholar 

  15. Magro M, Regar E, Gutierrez-Chico JL, Garcia-Garcia H, Simsek C, Schultz C, Zijlstra F, Serruys PW, van Geuns RJ (2013) Residual atherothrombotic material after stenting in acute myocardial infarction–an optical coherence tomographic evaluation. Int J Cardiol 167(3):656–663. https://doi.org/10.1016/j.ijcard.2012.03.073

    Article  PubMed  Google Scholar 

  16. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, Matsui H, Toki Y, Ito T, Hayakawa T (2000) Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 36(4):1202–1209

    Article  CAS  Google Scholar 

  17. van 't Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F, (1998) Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade. Zwolle Myocard Infarct Study Group Circulat 97(23):2302–2306

    Google Scholar 

  18. Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y, Sulimov V, Rosell Ortiz F, Ostojic M, Welsh RC, Carvalho AC, Nanas J, Arntz HR, Halvorsen S, Huber K, Grajek S, Fresco C, Bluhmki E, Regelin A, Vandenberghe K, Bogaerts K, Van de Werf F (2013) Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. New Eng J Med 368(15):1379–1387. https://doi.org/10.1056/NEJMoa1301092

    Article  CAS  PubMed  Google Scholar 

  19. Luo Y, Li J, Liu X, Xu J, Ye Z, Yao Y, Liu X, Lai Y (2016) Combination of P2Y12 reaction unit and percentage of platelet inhibition assessed by VerifyNow P2Y12 assay is a useful predictor of long-term clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Thromb Res 139:114–120. https://doi.org/10.1016/j.thromres.2016.01.020

    Article  CAS  PubMed  Google Scholar 

  20. Garcia-Garcia HM, Muramatsu T, Nakatani S, Lee IS, Holm NR, Thuesen L, van Geuns RJ, van der Ent M, Borovicanin V, Paunovic D, Onuma Y, Serruys PW (2014) Serial optical frequency domain imaging in STEMI patients: the follow-up report of TROFI study. Eur Heart J Cardiovasc Imag 15(9):987–995. https://doi.org/10.1093/ehjci/jeu042

    Article  Google Scholar 

  21. Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 59(12):1058–1072. https://doi.org/10.1016/j.jacc.2011.09.079

    Article  PubMed  Google Scholar 

  22. Kajander OA, Koistinen LS, Eskola M, Huhtala H, Bhindi R, Niemela K, Jolly SS, Sheth T (2015) Feasibility and repeatability of optical coherence tomography measurements of pre-stent thrombus burden in patients with STEMI treated with primary PCI. Eur Heart J Cardiovasc Imag 16(1):96–107. https://doi.org/10.1093/ehjci/jeu175

    Article  Google Scholar 

  23. Prati F, Capodanno D, Pawlowski T, Ramazzotti V, Albertucci M, La Manna A, Di Salvo M, Gil RJ, Tamburino C (2010) Local delivery versus intracoronary infusion of abciximab in patients with acute coronary syndromes. JACC Cardiovasc intervent 3(9):928–934. https://doi.org/10.1016/j.jcin.2010.05.017

    Article  Google Scholar 

  24. Prati F, Romagnoli E, Burzotta F, Limbruno U, Gatto L, La Manna A, Versaci F, Marco V, Di Vito L, Imola F, Paoletti G, Trani C, Tamburino C, Tavazzi L, Mintz GS (2015) Clinical Impact of OCT findings during PCI: the CLI-OPCI II study. JACC Cardiovasc imag 8(11):1297–1305. https://doi.org/10.1016/j.jcmg.2015.08.013

    Article  Google Scholar 

  25. Soeda T, Uemura S, Park SJ, Jang Y, Lee S, Cho JM, Kim SJ, Vergallo R, Minami Y, Ong DS, Gao L, Lee H, Zhang S, Yu B, Saito Y, Jang IK (2015) Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation 132(11):1020–1029. https://doi.org/10.1161/circulationaha.114.014704

    Article  PubMed  Google Scholar 

  26. Gibson CM, de Lemos JA, Murphy SA, Marble SJ, McCabe CH, Cannon CP, Antman EM, Braunwald E (2001) Combination therapy with abciximab reduces angiographically evident thrombus in acute myocardial infarction: a TIMI 14 substudy. Circulation 103(21):2550–2554

    Article  CAS  Google Scholar 

  27. Gibson CM, Schomig A (2004) Coronary and myocardial angiography: angiographic assessment of both epicardial and myocardial perfusion. Circulation 109(25):3096–3105. https://doi.org/10.1161/01.cir.0000134278.50359.cb

    Article  PubMed  Google Scholar 

  28. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial (2006). Lancet 367 (9510):569–578. doi:10.1016/s0140–6736(06)68147–6

  29. Bonnefoy E, Lapostolle F, Leizorovicz A, Steg G, McFadden EP, Dubien PY, Cattan S, Boullenger E, Machecourt J, Lacroute JM, Cassagnes J, Dissait F, Touboul P (2002) Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet 360(9336):825–829. https://doi.org/10.1016/s0140-6736(02)09963-4

    Article  PubMed  Google Scholar 

  30. Bainey KR, Armstrong PW, Zheng Y, Brass N, Tyrrell BD, Leung R, Westerhout CM, Welsh RC (2019) Pharmacoinvasive strategy versus primary percutaneous coronary intervention in st-elevation myocardial infarction in clinical practice: insights from the vital heart response registry. Circulat Cardiovasc Intervent 12(10):e008059. https://doi.org/10.1161/circinterventions.119.008059

    Article  CAS  Google Scholar 

  31. Gershlick AH, Stephens-Lloyd A, Hughes S, Abrams KR, Stevens SE, Uren NG, de Belder A, Davis J, Pitt M, Banning A, Baumbach A, Shiu MF, Schofield P, Dawkins KD, Henderson RA, Oldroyd KG, Wilcox R (2005) Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. New Eng J Med 353(26):2758–2768. https://doi.org/10.1056/NEJMoa050849

    Article  CAS  PubMed  Google Scholar 

  32. O'Donoghue M, Wiviott SD (2006) Clopidogrel response variability and future therapies: clopidogrel: does one size fit all? Circulation 114(22):e600–606. https://doi.org/10.1161/circulationaha.106.643171

    Article  PubMed  Google Scholar 

  33. Savcic M, Hauert J, Bachmann F, Wyld PJ, Geudelin B, Cariou R (1999) Clopidogrel loading dose regimens: kinetic profile of pharmacodynamic response in healthy subjects. Semin Thromb Hemost 25(Suppl 2):15–19

    CAS  PubMed  Google Scholar 

  34. Huczek Z, Filipiak KJ, Kochman J, Piatkowski R, Grabowski M, Roik M, Malek LA, Jaworski P, Opolski G (2007) Baseline platelet reactivity in acute myocardial infarction treated with primary angioplasty–influence on myocardial reperfusion, left ventricular performance, and clinical events. Am Heart J 154(1):62–70. https://doi.org/10.1016/j.ahj.2007.03.021

    Article  PubMed  Google Scholar 

  35. Roule V, Schwob L, Lemaitre A, Bignon M, Ardouin P, Sabatier R, Blanchart K, Beygui F (2019) Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion-An optical frequency domain imaging study. Catheterizat Cardiovasc Intervent. https://doi.org/10.1002/ccd.28429

    Article  Google Scholar 

  36. Amabile N, Hammas S, Fradi S, Souteyrand G, Veugeois A, Belle L, Motreff P, Caussin C (2015) Intra-coronary thrombus evolution during acute coronary syndrome: regression assessment by serial optical coherence tomography analyses. Eur Heart J Cardiovasc Imag 16(4):433–440. https://doi.org/10.1093/ehjci/jeu228

    Article  CAS  Google Scholar 

  37. Niccoli G, Burzotta F, Galiuto L, Crea F (2009) Myocardial no-reflow in humans. J Am Coll Cardiol 54(4):281–292. https://doi.org/10.1016/j.jacc.2009.03.054

    Article  PubMed  Google Scholar 

  38. Parodi G, Xanthopoulou I, Bellandi B, Gkizas V, Valenti R, Karanikas S, Migliorini A, Angelidis C, Abbate R, Patsilinakos S, Baldereschi GJ, Marcucci R, Gensini GF, Antoniucci D, Alexopoulos D (2015) Ticagrelor crushed tablets administration in STEMI patients: the MOJITO study. J Am Coll Cardiol 65(5):511–512. https://doi.org/10.1016/j.jacc.2014.08.056

    Article  PubMed  Google Scholar 

  39. Berwanger O, Nicolau JC, Carvalho AC, Jiang L, Goodman SG, Nicholls SJ, Parkhomenko A, Averkov O, Tajer C, Malaga G, Saraiva JFK, Fonseca FA, De Luca FA, Guimaraes HP, de Barros ESPGM, Damiani LP, Paisani DM, Lasagno CMR, Candido CT, Valeis N, Moia DDF, Piegas LS, Granger CB, White HD, Lopes RD (2018) Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with st-elevation myocardial infarction: a randomized clinical trial. JAMA Cardiol 3(5):391–399. https://doi.org/10.1001/jamacardio.2018.0612

    Article  PubMed  PubMed Central  Google Scholar 

  40. Alexopoulos D, Perperis A, Koniari I, Karvounis H, Patsilinakos S, Ziakas A, Barampoutis N, Panagiotidis T, Akinosoglou K, Hahalis G, Xanthopoulou I (2015) Ticagrelor versus high dose clopidogrel in ST-segment elevation myocardial infarction patients with high platelet reactivity post fibrinolysis. J Thromb Thrombolysis 40(3):261–267. https://doi.org/10.1007/s11239-015-1183-9

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The study was supported by a grant from Terumo. The funder has no role in any step of the study.

Author information

Authors and Affiliations

  1. CHU de Caen Normandie, Service de Cardiologie, Caen, 14000, France

    Vincent Roule, Lin Schwob, Clément Briet, Adrien Lemaitre, Mathieu Bignon, Pierre Ardouin, Rémi Sabatier, Katrien Blanchart & Farzin Beygui

  2. UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d′ischémie-reperfusion myocardique, Normandie Univ, Caen, 14000, France

    Vincent Roule & Farzin Beygui

Authors
  1. Vincent Roule
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lin Schwob
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clément Briet
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adrien Lemaitre
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mathieu Bignon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pierre Ardouin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rémi Sabatier
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katrien Blanchart
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Farzin Beygui
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

VR, LS and CB: analysis and interpretation of data; VR: drafting of the manuscript; AL MB RS PA KB: analysis of data, manuscript revision; FB: design, statistical analysis and revision; All: final approval of the manuscript submitted.

Corresponding author

Correspondence to Vincent Roule.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

The studies were approved by the ethics committee (Comité de Protection des Personnes EST I—Dossier 2017–43—ID RCB:2017-A01442-51). The studies are registered on ClinicalTrials.gov under the identifiers NCT02850315 and NCT03342521.

Informed consent

All patients provided written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 25 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roule, V., Schwob, L., Briet, C. et al. Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre-hospital fibrinolysis compared to primary PCI. J Thromb Thrombolysis 50, 858–866 (2020). https://doi.org/10.1007/s11239-020-02113-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-020-02113-8

Keywords

Search

Navigation