Impact of antiplatelet therapy on tissue prolapse at super acute phase after stenting: serial OCT study in acute coronar
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ORIGINAL ARTICLE
Impact of antiplatelet therapy on tissue prolapse at super acute phase after stenting: serial OCT study in acute coronary syndrome patients Kazuhiro Naito1 · Yusuke Nakano1 · Katsuhisa Waseda1,2 · Hiroaki Takashima1 · Hirohiko Ando1 · Shinichiro Sakurai1 · Akihiro Suzuki1 · Yuki Saka1 · Hiroaki Sawada1 · Shigeko Nagahiro1 · Mayu Suzuki1 · Masahiro Shimoda1 · Tetsuya Amano1 Received: 6 February 2020 / Accepted: 28 August 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Although drug-eluting stents have improved clinical outcomes, percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains a challenging procedure in terms of thrombus management. A new-generation P2Y12 receptor inhibitor, prasugrel, provides more rapid and potent antiplatelet action compared with clopidogrel. Prasugrel achieved significant reduction of ischemic events compared with clopidogrel in ACS. The aim of this optical coherence tomography (OCT) study was to evaluate temporal changes in tissue prolapse after stenting under different antiplatelet regimens (aspirin plus prasugrel or clopidogrel) in ACS patients. A total of 119 ACS patients were randomized to either prasugrel or clopidogrel at the time of PCI. OCT analysis was available in 119 patients at baseline (just after stenting), 77 patients at 2 weeks, and 62 patients at 4 months after stenting. Cross-sectional analysis for every 1 mm was performed at in-stent and adjacent reference segment. Tissue prolapse area was calculated by lumen area minus stent area within the stented segment. Baseline patient and procedural characteristics were not different between the prasugrel and clopidogrel groups. Tissue prolapse area was significantly lower in the prasugrel compared with the clopidogrel group after stenting (0.24 ± 0.23 vs. 0.36 ± 0.23 m m2, p = 0.003) 2 and at 2 weeks (0.11 ± 0.13 vs. 0.19 ± 0.16 m m , p = 0.005). However, there was no significant difference at 4 months. In conclusion, our study suggests prasugrel was effective in reducing tissue prolapse in the super acute phase in ACS patients compared with clopidogrel. However, the effect of tissue prolapse reduction was not different up to 4 months follow-up. Keywords Acute coronary syndrome · Optical coherence tomography · Prasugrel · Tissue prolapse
Introduction Antiplatelet therapy is an important treatment to prevent ischemic complications in patients undergoing percutaneous coronary intervention (PCI). PCI patients are usually prescribed dual antiplatelet therapy with aspirin and a thienopyridine, such as clopidogrel, which is widely used to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00380-020-01686-x) contains supplementary material, which is available to authorized users. * Katsuhisa Waseda waseda‑[email protected] 1
Department of Cardiology, Aichi Medical University, 1‑1, Yazakokarimata, Nagakute, Aichi 480‑1195, Japan
Medical Education Center, Aichi Medical University, Nagakute, Japan
2
prevent thromb
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