• Thea C Godschalk, Robert A Byrne, Tom Adriaenssens, Nikesh Malik, Laurent J Feldman, Giulio Guagliumi, Fernando Alfonso, Franz-Josef Neumann, Dietmar Trenk, Michael Joner, Christian Schulz, Philippe G Steg, Alison H Goodall, Roman Wojdyla, Dariusz Dudek, Joanna J Wykrzykowska, Ota Hlinomaz, Azfar G Zaman, Nick Curzen, Jo Dens, Peter Sinnaeve, Walter Desmet, Anthony H Gershlick, Adnan Kastrati, Steffen Massberg, Jurriën M Ten Berg, and PRESTIGE Investigators.
• Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
• JACC Cardiovasc Interv. 2017 Dec 26; 10 (24): 2548-2556.

ObjectivesHigh platelet reactivity (HPR) was studied in patients presenting with ST-segment elevation myocardial infarction (STEMI) due to stent thrombosis (ST) undergoing immediate percutaneous coronary intervention (PCI).BackgroundHPR on P2Y12 inhibitors (HPR-ADP) is frequently observed in stable patients who have experienced ST. The HPR rates in patients presenting with ST for immediate PCI are unknown.MethodsConsecutive patients presenting with definite ST were included in a multicenter ST registry. Platelet reactivity was measured before immediate PCI with the VerifyNow P2Y12 or Aspirin assay.ResultsPlatelet reactivity was measured in 129 ST patients presenting with STEMI undergoing immediate PCI. HPR-ADP was observed in 76% of the patients, and HPR on aspirin (HPR-AA) was observed in 13% of the patients. HPR rates were similar in patients who were on maintenance P2Y12 inhibitor or aspirin since stent placement versus those without these medications. In addition, HPR-ADP was similar in patients loaded with a P2Y12 inhibitor shortly before immediate PCI versus those who were not. In contrast, HPR-AA trended to be lower in patients loaded with aspirin as compared with those not loaded.ConclusionsApproximately 3 out of 4 ST patients with STEMI undergoing immediate PCI had HPR-ADP, and 13% had HPR-AA. Whether patients were on maintenance antiplatelet therapy while developing ST or loaded with P2Y12 inhibitors shortly before undergoing immediate PCI had no influence on the HPR rates. This raises concerns that the majority of patients with ST have suboptimal platelet inhibition undergoing immediate PCI.Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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