title: 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].
abstract: 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.
  
  
  RESULTS
  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.
authors.affiliation: Bristol Heart Institute, Bristol, United Kingdom.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Johnson
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Mumford
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Scott
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Stuart
authors.initials: S
authors.lastname: Mundell
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Butler
authors.affiliation: Bristol Heart Institute, Bristol, United Kingdom.
authors.forename: Julian W
authors.initials: JW
authors.lastname: Strange
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.affiliation: University of Bristol, Bristol, United Kingdom.
authors.forename: Barnaby C
authors.initials: BC
authors.lastname: Reeves
authors.affiliation: Bristol Heart Institute, Bristol, United Kingdom.
authors.forename: Andreas
authors.initials: A
authors.lastname: Baumbach
mesh_terms: D000368:Aged; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D010979:Platelet Function Tests; D019095:Point-of-Care Systems; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors