Journal of Thrombosis and Circulation: Open Access

Abstract

Effects of Baseline Platelet Reactivity on Thrombolysis in Myocardial Infarction Flow and Ischemic Time in Fibrinolysis-treated ST Elevation Myocardial Infarction Patients

Sin P, Yang A, Pon Q, Lavoie A, Crawford JJ, Harenberg S, Zimmermann RH, Booker J, Kelly S, Lavi S, Cantor WJ, Mehta SR, Bagai A, Goodman SG, Cheema A and Dehghani P

Objective: Thrombolysis in Myocardial Infarction (TIMI) flow in ST-Elevation Myocardial Infarction (STEMI) is aprognostic predictor that is directly influenced by duration of culprit artery occlusion; ischemic time. It is unknownwhether platelet reactivity measured by P2Y12 reaction unit (PRU) is affected by ischemic time or predictive of TIMIflow. Our objectives were to examine the effect of baseline PRU on TIMI flow and on ischemic time.

Methods: Between May 2014 and August 2016, the study included 144 patients between four sites undergoingpercutaneous coronary intervention (PCI) within 24 hours of tenecteplase, aspirin and clopidogrel for STEMI. TheVerifyNow® Assay measured baseline PRU prior to angiography. Ischemic time was defined as the duration betweenindex symptom onset and tenecteplase administration. Kruskal-Wallis H test was conducted because theassumption of normality was violated to test differences in baseline PRU based on TIMI flow and based on timeintervals prior to PCI.

Results: Median ischemic time was 172 minutes (IQR 115-285). Baseline PRU did not differ based on TIMI flowgrade {χ2(3)=3.00, p=0.39}. Baseline PRU was not affected based on ischemic time {χ2(3)=1.50, p=0.68)}.

Conclusion: Platelet reactivity measured by PRU is not associated with TIMI flow or ischemic time. Futureresearch is warranted to examine the association between baseline PRU and prognosis.

Abstract Key Points: Effect of baseline platelet reactivity measured by PRU on TIMI flow and on ischemic timewas examined.

Between May 2014 and August 2016, 144 patients undergoing percutaneous coronary intervention within 24hours of fibrinolysis for STEMI were included

In STEMI patients treated with fibrinolysis, baseline PRU at the time of angiography does not correlate with TIMIflow or ischemic time.