Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre
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Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre‑hospital fibrinolysis compared to primary PCI Vincent Roule1,2 · Lin Schwob1 · Clément Briet1 · Adrien Lemaitre1 · Mathieu Bignon1 · Pierre Ardouin1 · Rémi Sabatier1 · Katrien Blanchart1 · Farzin Beygui1,2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
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. Keywords Fibrinolysis · Primary PCI · Platelet reactivity · Rhrombus
Highlights • When successfully treated by PI, patients presented a
lower thrombotic burden after PCI possibly explaining their more optimal myocardial reperfusion compared to primary PCI patients. • Both groups had high rates of high on-treatment platelet reactivity despite pre-treatment. • These findings reinforce the use of a pharmacoinvasive reperfusion strategy when primary PCI cannot be timely performed.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02113-8) contains supplementary material, which is available to authorized users. * Vincent Roule roule‑v@chu‑caen.fr 1
CHU de Caen Normandie, Service de Cardiologie, Caen 14000, France
UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d′ischémie‑reperfusion myocardique, Normandie Univ, Caen 14000, France
2
Introduction Primary percutaneous coronary intervention (PCI) is considered as the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI), provided it can be performed expeditiously by an experienced team [1]. However achieving a total ischemic time 200 μm. The presence of irregular protrusion and atherothrombotic protrusion > 500 µm in thickness (Fig. 1) was measured as previously described [24, 25].
Angiographic analysis Coronary angiograms were analyzed before PCI and at the end of the procedure to evaluate basal and post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grade, pre-PCI angiographic thrombus grade and post-PCI MBG, on angiography at 30 frames/sec using the best projection to assess the myocardial region of the infarct-related coronary artery, as previously described [26, 27]. Angiographic runs had to be long enough to allow filling of the venous coronary system. Since angiographic thrombus score grade 5 equals total occlusion, patients initially presenting in this group were reclassified into one of th
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