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TIME RELATED BENEFIT OF ANTIPLATELET THERAPY ON CORONARY REPERFUSION IN ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS
257 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease TIME RELATED BENEFIT OF ANTIPLATELET THERAPY ON CORONARY REPERFUSION IN STELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Antiplatelet and Antithrombotic Agents in Ischemic Heart Disease Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy Presentation Number: 1296-303 Authors: Martino Pepe, Filippo Masi, Nicola Signore, Alessandro Santo Bortone, Annagrazia Cecere, Antonio Tito, Domenico Zanna, Donato Quagliara, Stefano Favale, Cardiovascular Diseases Section, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy, Institute of Cardiac Surgery, University of Bari, Bari, Italy
Background: The goal of STEMI treatment is early reperfusion. The new oral P2Y12 inhibitors (P2Y12-I) prasugrel and ticagrelor demonstrated to improve angiographic results of primary percutaneous coronary intervention (pPCI) and clinical prognosis, but their onset of action is significantly impaired in STEMI patients. Aim of our observational study was to establish if the benefit of the P2Y12-I loading dose (LD) administration is time related.
Methods: A total of 250 consecutive patients with STEMI (81.3% males, 65.5±12.5 years old, 33.5% diabetics) addressed to pPCI were enrolled. Cardiogenic shock was an exclusion criterion. We divided our population into three groups depending of the time interval from “P2Y12-I LD administration to balloon”: the first group included patients receiving P2Y12-I LD at least 60 minutes before pPCI, the second group within the 60 minutes before pPCI, the third group at the moment of pPCI after angiography. Two skilled interventional cardiologists evaluated the TIMI flow grade (TFG) of the culprit artery in the first angiogram immediately prior to PCI and post pPCI in a double blinded fashion.
Results: Pre-pPCI TFG decreased throughout the groups proportionally to the increasing “P2Y12-I LD administration to balloon” time; we found the following rates of pre-pPCI TFG 0/1: 51.3% in the first group, 62.1% in the second group, 83.2% in the third group (p< 0.001). Moreover post-pPCI TFG was significantly different in the three groups (p<0.001): it improved throughout the groups proportionally to the increasing “ P2Y12-I LD administration to balloon” time with the following rates: 97.4% in the first group, 88.4% in the second group, 82.2% in the third Group.
Conclusions: Despite rapid initiation is recommended, absorption and effectiveness of P2Y12-I is known to be impaired in STEMI patients. Our observational study is the first evidence of a progressive time-related angiographic benefit of P2Y12-I LD administration: a longer time window between P2Y12-I administration and pPCI significantly improves coronary reperfusion in terms of both pre and post pPCI TFG; this finding supports the relevance of P2Y12-I LD administration as soon as possible at first medical contact.
Acute and Stable Ischemic Heart Disease TIME RELATED BENEFIT OF ANTIPLATELET THERAPY ON CORONARY REPERFUSION IN STELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS Poster Contributions Poster Hall, Hall C Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m. Session Title: Antiplatelet and Antithrombotic Agents in Ischemic Heart Disease Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy Presentation Number: 1296-303 Authors: Martino Pepe, Filippo Masi, Nicola Signore, Alessandro Santo Bortone, Annagrazia Cecere, Antonio Tito, Domenico Zanna, Donato Quagliara, Stefano Favale, Cardiovascular Diseases Section, Department of Emergency & Organ Transplantation, University of Bari, Bari, Italy, Institute of Cardiac Surgery, University of Bari, Bari, Italy
Background: The goal of STEMI treatment is early reperfusion. The new oral P2Y12 inhibitors (P2Y12-I) prasugrel and ticagrelor demonstrated to improve angiographic results of primary percutaneous coronary intervention (pPCI) and clinical prognosis, but their onset of action is significantly impaired in STEMI patients. Aim of our observational study was to establish if the benefit of the P2Y12-I loading dose (LD) administration is time related.
Methods: A total of 250 consecutive patients with STEMI (81.3% males, 65.5±12.5 years old, 33.5% diabetics) addressed to pPCI were enrolled. Cardiogenic shock was an exclusion criterion. We divided our population into three groups depending of the time interval from “P2Y12-I LD administration to balloon”: the first group included patients receiving P2Y12-I LD at least 60 minutes before pPCI, the second group within the 60 minutes before pPCI, the third group at the moment of pPCI after angiography. Two skilled interventional cardiologists evaluated the TIMI flow grade (TFG) of the culprit artery in the first angiogram immediately prior to PCI and post pPCI in a double blinded fashion.
Results: Pre-pPCI TFG decreased throughout the groups proportionally to the increasing “P2Y12-I LD administration to balloon” time; we found the following rates of pre-pPCI TFG 0/1: 51.3% in the first group, 62.1% in the second group, 83.2% in the third group (p< 0.001). Moreover post-pPCI TFG was significantly different in the three groups (p<0.001): it improved throughout the groups proportionally to the increasing “ P2Y12-I LD administration to balloon” time with the following rates: 97.4% in the first group, 88.4% in the second group, 82.2% in the third Group.
Conclusions: Despite rapid initiation is recommended, absorption and effectiveness of P2Y12-I is known to be impaired in STEMI patients. Our observational study is the first evidence of a progressive time-related angiographic benefit of P2Y12-I LD administration: a longer time window between P2Y12-I administration and pPCI significantly improves coronary reperfusion in terms of both pre and post pPCI TFG; this finding supports the relevance of P2Y12-I LD administration as soon as possible at first medical contact.