INTERVENTIONAL CARDIOLOGY
Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction
Nicolette M.S.K.J. Ernst, MD*,
Harry Suryapranata, MD, PhD, FACC*,
Kor Miedema, MD, PhD ,
Robbert J. Slingerland, MD, MSc, PhD,
Jan Paul Ottervanger, MD, PhD*,
Jan C.A. Hoorntje, MD, PhD*,
A.T.Marcel Gosselink, MD, PhD*,
Jan-Henk E. Dambrink, MD, PhD*,
Menko-Jan de Boer, MD, PhD, FACC*,
Felix Zijlstra, MD, PhD, FACC and
Arnoud W.J. van’t Hof, MD, PhD*,*
* Isala Klinieken, location Weezenlanden, Department of Cardiology, Zwolle, the Netherlands
Isala Klinieken, location Weezenlanden, Department of Clinical Chemistry, Zwolle, the Netherlands
Thorax Centre, Department of Cardiology, Groningen, the Netherlands
Manuscript received March 18, 2004;
revised manuscript received May 13, 2004,
accepted June 7, 2004.
* Reprint requests and correspondence: Dr. Arnoud W. J. van ’t Hof, Isala Klinieken, location Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, the Netherlands (Email: v.r.c.derks{at}isala.nl).
OBJECTIVES: To evaluate the extent of platelet aggregation inhibition in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), treated with different antiplatelet agents and dosages.
BACKGROUND: The extent of platelet aggregation inhibition is an independent predictor of major cardiac events after elective PCI. In STEMI patients undergoing PCI, routine dose of antiplatelet agents may be associated with less effective platelet aggregation inhibition.
METHODS: Patients were treated with clopidogrel before angiography and randomized to abciximab, tirofiban, high-dose tirofiban, or no glycoprotein (GP) IIb/IIIa inhibitor; GP IIb/IIIa inhibitor bolus, followed by maintenance infusion, was administered after angiography, but before PCI. Platelet aggregation inhibition was assessed before angiography, immediately after PCI, and 1 and 6 h afterwards.
RESULTS: The total study population consisted of 112 patients. Platelet aggregation inhibition was variable for individuals and suboptimal for all agents, particularly in the periprocedural period. Only with high-dose tirofiban, mean periprocedural platelet aggregation inhibition exceeded 80%. Angiographic parameters after PCI were not different between the groups. No relationship was found between the level of platelet aggregation and parameters of PCI success (Thrombolysis In Myocardial Infarction frame count and myocardial blush grade), after combining the data from all four groups studied.
CONCLUSIONS: Platelet aggregation inhibition in STEMI patients undergoing PCI, treated with antiplatelet agents, is variable and suboptimal for all agents and dosages studied. Only with high-dose tirofiban, mean periprocedural platelet aggregation inhibition exceeded 80%. However, no relationship of platelet aggregation inhibition and angiographic outcome was found in this patient cohort.
|
Abbreviations and Acronyms
| | GP = glycoprotein | | PCI = percutaneous coronary intervention | | STEMI = ST-segment elevation myocardial infarction |
|
This article has been cited by other articles:
|
|
|
|
 
G. De Luca, G. Ucci, E. Cassetti, and P. Marino
Benefits from small molecule administration as compared with abciximab among patients with ST-segment elevation myocardial infarction treated with primary angioplasty: a meta-analysis.
J. Am. Coll. Cardiol.,
May 5, 2009;
53(18):
1668 - 1673.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C.-C. Fang, Yeun Tarl Fresner NgJao, Yi Chen, C.-L. Yu, and S.-P. Wang
Glycoprotein IIb/IIIa Inhibitor (Tirofiban) in Acute ST-Segment Elevation Myocardial Infarction
Angiology,
April 1, 2009;
60(2):
192 - 200.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Marzocchi, A. Manari, G. Piovaccari, C. Marrozzini, S. Marra, P. Magnavacchi, P. Sangiorgio, L. Marinucci, N. Taglieri, G. Gordini, et al.
Randomized comparison between tirofiban and abciximab to promote complete ST-resolution in primary angioplasty: results of the facilitated angioplasty with tirofiban or abciximab (FATA) in ST-elevation myocardial infarction trial
Eur. Heart J.,
December 2, 2008;
29(24):
2972 - 2980.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G De Luca, C M Gibson, F Bellandi, S Murphy, M Maioli, M Noc, U Zeymer, D Dudek, H-R Arntz, S Zorman, et al.
Early glycoprotein IIb-IIIa inhibitors in primary angioplasty (EGYPT) cooperation: an individual patient data meta-analysis
Heart,
December 1, 2008;
94(12):
1548 - 1558.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. De Luca
Adjunctive antithrombotic therapy during primary percutaneous coronary intervention
Eur. Heart J. Suppl.,
December 1, 2008;
10(suppl_J):
J2 - J14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Gumina, E. H. Yang, G. S. Sandhu, A. Prasad, J. F. Bresnahan, R. J. Lennon, C. S. Rihal, D. R. Holmes Jr, and M. Singh
Survival Benefit With Concomitant Clopidogrel and Glycoprotein IIb/IIIa Inhibitor Therapy at Ad Hoc Percutaneous Coronary Intervention
Mayo Clin. Proc.,
September 1, 2008;
83(9):
995 - 1001.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Valgimigli, G. Campo, G. Percoco, L. Bolognese, C. Vassanelli, S. Colangelo, N. de Cesare, A. E. Rodriguez, M. Ferrario, R. Moreno, et al.
Comparison of Angioplasty With Infusion of Tirofiban or Abciximab and With Implantation of Sirolimus-Eluting or Uncoated Stents for Acute Myocardial Infarction: The MULTISTRATEGY Randomized Trial
JAMA,
April 16, 2008;
299(15):
1788 - 1799.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Dobrzycki, P. Kralisz, K. Nowak, P. Prokopczuk, W. Kochman, J. Korecki, B. Poniatowski, J. Zuk, E. Sitniewska, H. Bachorzewska-Gajewska, et al.
Transfer with GP IIb/IIIa inhibitor tirofiban for primary percutaneous coronary intervention vs. on-site thrombolysis in patients with ST-elevation myocardial infarction (STEMI): a randomized open-label study for patients admitted to community hospitals
Eur. Heart J.,
October 2, 2007;
28(20):
2438 - 2448.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Jernberg, C. D. Payne, K. J. Winters, C. Darstein, J. T. Brandt, J. A. Jakubowski, H. Naganuma, A. Siegbahn, and L. Wallentin
Prasugrel achieves greater inhibition of platelet aggregation and a lower rate of non-responders compared with clopidogrel in aspirin-treated patients with stable coronary artery disease
Eur. Heart J.,
May 2, 2006;
27(10):
1166 - 1173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Bolognese, G. Falsini, F. Liistro, P. Angioli, K. Ducci, T. Taddei, R. Tarducci, F. Cosmi, S. Baldassarre, and A. Burali
Randomized Comparison of Upstream Tirofiban Versus Downstream High Bolus Dose Tirofiban or Abciximab on Tissue-Level Perfusion and Troponin Release in High-Risk Acute Coronary Syndromes Treated With Percutaneous Coronary Interventions: The EVEREST Trial
J. Am. Coll. Cardiol.,
February 7, 2006;
47(3):
522 - 528.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Svilaas, I. C.C. van der Horst, and F. Zijlstra
The role of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention for ST elevation myocardial infarction
Eur. Heart J.,
December 1, 2005;
26(23):
2479 - 2481.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Timmer, J. P. Ottervanger, M.-J. de Boer, J.-H. E. Dambrink, J. C.A. Hoorntje, A.T. M. Gosselink, H. Suryapranata, F. Zijlstra, A. W.J. van't Hof, and Zwolle Myocardial Infarction Study Group
Hyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarction
J. Am. Coll. Cardiol.,
April 5, 2005;
45(7):
999 - 1002.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al.
Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology
Eur. Heart J.,
April 2, 2005;
26(8):
804 - 847.
[Full Text]
[PDF]
|
|
|
|
