A Study of Platelet Inhibition, Using a ‘Point of Care’ Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction PINPOINT-PPCIReport as inadecuate




A Study of Platelet Inhibition, Using a ‘Point of Care’ Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction PINPOINT-PPCI - Download this document for free, or read online. Document in PDF available to download.

Background

Rapid coronary recanalization following ST-elevation myocardial infarction STEMI requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ‘door-to-end’ time and baseline platelet activity on platelet inhibition within 24hours post-STEMI.

Methods and Findings

108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events MACE, bleeding and stent thrombosis ST were recorded. Baseline ADP activity was high 88.3U 71.8–109.0, procedural time and consequently bivalirudin infusion duration were short median door-to-end time 55minutes 40–70 and infusion duration 30minutes 20–42. Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity HRPR ADP>46.8U was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE 4.6%. Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention.

Conclusions

Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.



Author: Thomas W. Johnson , Andrew D. Mumford, Lauren J. Scott, Stuart Mundell, Mark Butler, Julian W. Strange, Chris A. Rogers, Barnaby

Source: http://plos.srce.hr/



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