Platelet-Derived Thrombogenicity Measured by Total Thrombus-Formation Analysis System in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

• Published in: Circulation Journal 2020/05/25, Vol.84(6), pp.975-984
• Main Authors: Kikuchi, Shinnosuke, Tsukahara, Kengo, Ichikawa, Shinya, Abe, Takeru, Minamimoto, Yugo, Kimura, Yuichiro, Akiyama, Eiichi, Nakayama, Naoki, Okada, Kozo, Matsuzawa, Yasushi, Konishi, Masaaki, Maejima, Nobuhiko, Iwahashi, Noriaki, Hibi, Kiyoshi, Kosuge, Masami, Ebina, Toshiaki, Tamura, Kouichi, Kimura, Kazuo
• Format: Article
• Language: English
• Subjects: Aged; Blood Platelets - drug effects; Blood Platelets - metabolism; Drug Monitoring - instrumentation; Equipment Design; Female; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Humans; Infarct size; Lab-On-A-Chip Devices; Male; Microchip Analytical Procedures; Middle Aged; No-Reflow Phenomenon - blood; No-Reflow Phenomenon - etiology; Percutaneous Coronary Intervention - adverse effects; Platelet function test; Platelet Function Tests - instrumentation; Platelet-derived thrombogenicity; Predictive Value of Tests; Prospective Studies; Risk Factors; ST Elevation Myocardial Infarction - blood; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - therapy; ST-elevation myocardial infarction; Thrombosis - blood; Thrombosis - diagnosis; Thrombosis - etiology; Thrombosis - prevention & control; Treatment Outcome
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-19-1043

Background:Prompt and potent antiplatelet effects are important aspects of management of ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). We evaluated the association between platelet-derived thrombogenicity during PPCI and enzymatic infarct size in STEMI patients.Methods and Results:Platelet-derived thrombogenicity was assessed in 127 STEMI patients undergoing PPCI by: (1) the area under the flow-pressure curve for the PL-chip (PL18-AUC10) using the total thrombus-formation analysis system (T-TAS); and (2) P2Y12reaction units (PRU) using the VerifyNow system. Patients were divided into 2 groups (High and Low) based on median PL18-AUC10during PPCI. PRU levels during PPCI were suboptimal in both the High and Low PL18-AUC10groups (median [interquartile range] 266 [231–311] vs. 272 [217–317], respectively; P=0.95). The percentage of final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was lower in the High PL18-AUC10group (75% vs. 90%; P=0.021), whereas corrected TIMI frame count (31.3±2.5 vs. 21.0±2.6; P=0.005) and the incidence of slow-flow/no-reflow phenomenon (31% vs. 11%, P=0.0055) were higher. The area under the curve for creatine kinase (AUCCK) was greater in the High PL18-AUC10group (95,231±7,275 IU/L h vs. 62,239±7,333 IU/L h; P=0.0018). Multivariate regression analysis identified high PL18-AUC10during PPCI (β=0.29, P=0.0006) and poor initial TIMI flow (β=0.37, P