High platelet reactivity on aspirin in patients with acute ST elevation myocardial infarction.
BACKGROUND
Despite dual antiplatelet treatment, major ischemic events are common following ST elevation myocardial infarction (STEMI). We aimed to assess high platelet reactivity on aspirin (HPR-aspirin) and its association with P2Y12i (HPR-P2Y12i) during the acute phase of STEMI.


METHODS
We included all consecutive patients admitted for STEMI treated by primary angioplasty in our center for 1year. All patients received a loading dose followed by a maintenance dose of aspirin (75mg/day) and prasugrel (ticagrelor or clopidogrel if contraindicated). Platelet reactivity was assessed 4±1days and 75±15days after admission using light transmission aggregometry with arachidonic acid (LTA-AA-HPR-aspirin) and VASP (HPR-P2Y12i) to define HPR as well as serum Thromboxane-B2 and LTA-ADP. Major cardiac and cerebrovascular events were recorded for 1year.


RESULTS
We included 106 patients - mean age was 61y.o., 76% were male and 20% had diabetes. STEMI was anterior in 52% and LV ejection fraction at discharge was 51±9%. 50% of patients were treated with prasugrel and 34% with ticagrelor. At day 4 after STEMI, HPR-aspirin was found in 26% patients and HPR-P2Y12i in 7%. HPR- both aspirin and P2Y12i was found in 4%. Diabetes and age were predictors of HPR-aspirin. HPR-aspirin was persistent 75days later in 36% patients. At 1year, 7.9% patients had experienced major adverse cardiovascular and cerebrovascular events (MACCE). HPR-aspirin and HPR on both aspirin and P2Y12i were significantly associated with MACCE.


CONCLUSIONS
HPR-aspirin is frequent just after STEMI and associated with MACCE especially when associated with HPR-P2Y12i.
Department of Cardiology, Lariboisiere Hospital, AP-HP, Paris Diderot University - INSERM U 942, Paris, France.
Jean-Guillaume
JG
Dillinger
Department of Cardiology, Lariboisiere Hospital, AP-HP, Paris Diderot University - INSERM U 942, Paris, France.
Alaa
A
Saeed
Department of Cardiology, Lariboisiere Hospital, AP-HP, Paris Diderot University - INSERM U 942, Paris, France.
Vincent
V
Spagnoli
Department of Angio-hematology and IVS, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France.
Claire Bal Dit
CB
Sollier
Department of Cardiology, Lariboisiere Hospital, AP-HP, Paris Diderot University - INSERM U 942, Paris, France.
Georgios
G
Sideris
Department of Cardiology, Lariboisiere Hospital, AP-HP, Paris Diderot University - INSERM U 942, Paris, France.
Stephane Manzo
SM
Silberman
Department of Cardiology, Lariboisiere Hospital, AP-HP, Paris Diderot University - INSERM U 942, Paris, France.
Sebastian
S
Voicu
Department of Angio-hematology and IVS, Lariboisiere Hospital, AP-HP, Paris Diderot University, Paris, France.
Ludovic
L
Drouet
Department of Cardiology, Lariboisiere Hospital, AP-HP, Paris Diderot University - INSERM U 942, Paris, France. Electronic address: patrick.henry@lrb.aphp.fr.
Patrick
P
Henry
D000208:Acute Disease; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D001792:Blood Platelets / Q000187:drug effects* / Q000473:pathology; D002545:Brain Ischemia / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016019:Survival Analysis; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin
Aspirin; Myocardial infarction; P2Y12 inhibitors; Platelet reactivity