Abstract
Background
Recent trials have failed to demonstrate any clinical benefit from pre-treatment with
dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary interventions,
(PCI), even in the setting of acute coronary syndrome. However, suboptimal platelet
inhibition during (PCI) has been shown to enhance the risk of acute ischemic complications,
such as stent thrombosis and periprocedural myocardial infarction (PMI), thus raising
the attention on the potential advantages of adjunctive glycoprotein IIbIIIa inhibitors
to obviate to the delayed onset of action of oral antiplatelet drugs. The aim of the
present study was then to evaluate the impact of platelet reactivity and pre-procedural
DAPT on PMI in patients undergoing PCI with adjunctive tirofiban.
Methods
In a consecutive cohort of patients undergoing PCI with tirofiban (intracoronary/intravenous ± prolonged
infusion), periprocedural myonecrosis was defined as troponin I increase by 3 times
the ULN or by 50% of an elevated baseline value, whereas PMI as CKMB increase by 3
times the ULN or 50% of baseline. Platelet function was assessed by impedance aggregometry.
Results
A total of 168 patients were included, 77 (45.8%) of whom were on DAPT at the time
of PCI. Patients on DAPT had more often a history of previous PCI (p = 0.03), higher ACS at admission (p < 0.001) and creatinine levels (p = 0.03). Coronary calcifications and type C lesions were more frequent in patients
without DAPT (p = 0.02 and p = 0.03, respectively), as much as TIMI flow < 3 (p = 0.03), while procedural characteristics were comparable. Baseline platelet reactivity
was significantly reduced in DAPT treated patients (p < 0.001 for ASPI, COL and ADP tests). However the rate of periprocedural myonecrosis
did not differ according to pre-procedural DAPT (68.4%vs 67%, p = 0.87; adjusted OR[95%CI] = 1.34[0.71–2.53], p = 0.36) and neither the occurrence of PMI (13.3% vs 12.6%, p = 0.99; adjusted OR[95%CI] = 1.24[0.51–3.1], p = 0.64). Furthermore, baseline platelet reactivity was similar in patients with and
without PMI/myonecrosis with no relationship between platelet function and Troponin
I peak.
Conclusion
In patients undergoing PCI with adjunctive GP IIb-IIIa inhibitors, preprocedural DAPT
and baseline platelet reactivity are not associated to the risk of periprocedural
myocardial infarction or myonecrosis. These data further support the role of periprocedural
Gp IIb-IIIa inhibitors in order to overcome any suboptimal inhibition of platelet
aggregation at the time of the procedure due to drug-resistance or delayed (downstream)
administration of ADP antagonists, especially in complex high-risk procedures.
Keywords
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Article info
Publication history
Published online: February 15, 2018
Accepted:
February 13,
2018
Received in revised form:
February 11,
2018
Received:
October 25,
2017
Identification
Copyright
© 2018 Published by Elsevier Ltd.
