Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance Imaging
Background Despite optimized medical management and techniques of primary percutaneous coronary intervention, a substantial proportion of patients with ST‐segment–elevation myocardial infarction (STEMI) display significant microvascular damage. Thrombotic microvascular obstruction (MVO) has been imp...
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| Format: | Article |
| Language: | English |
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Wiley
2022-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.020973 |
| _version_ | 1797630965145665536 |
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| author | Eias Massalha Daniel Oren Orly Goitein Yafim Brodov Alex Fardman Anan Younis Anat Berkovitch Shir Raibman‐Spector Eli Konen Elad Maor Paul Fefer Amit Segev Roy Beigel Shlomi Matetzky |
| author_facet | Eias Massalha Daniel Oren Orly Goitein Yafim Brodov Alex Fardman Anan Younis Anat Berkovitch Shir Raibman‐Spector Eli Konen Elad Maor Paul Fefer Amit Segev Roy Beigel Shlomi Matetzky |
| author_sort | Eias Massalha |
| collection | DOAJ |
| description | Background Despite optimized medical management and techniques of primary percutaneous coronary intervention, a substantial proportion of patients with ST‐segment–elevation myocardial infarction (STEMI) display significant microvascular damage. Thrombotic microvascular obstruction (MVO) has been implicated in the pathogenesis of microvascular and subsequent myocardial damage attributed to distal embolization and microvascular platelet plugging. However, there are only scarce data regarding the effect of platelet reactivity on MVO. Methods and Results We prospectively evaluated 105 patients in 2 distinct periods (2012–2013 and 2016–2018) who presented with first ST‐segment–elevation myocardial infarction and underwent primary percutaneous coronary intervention. All patients were treated with dual antiplatelet therapy (DAPT). Blood samples were analyzed for platelet reactivity, and cardiac magnetic resonance imaging scans were evaluated for late gadolinium enhancement and MVO. DAPT suboptimal response was defined as hyporesponsiveness to either aspirin or P2Y12 receptor inhibitor agents and demonstrated in 31 patients (29.5%) of the current cohort. Suboptimal platelet response to DAPT was associated with a significantly greater extent of MVO when expressed as a percentage of the left ventricular mass, left ventricular scar, and the number of myocardial left ventricular segments showing MVO (P<0.01 for each). Adjusted multivariable logistic regression model revealed that suboptimal response to DAPT is significantly associated with both greater late gadolinium enhancement (P<0.01) and MVO extent (odds ratio, 3.7 [95% CI, 1.3–10.5]; P=0.01). Patients with a greater extent of MVO were more likely to sustain major adverse cardiovascular events at a 1‐year follow‐up (37% versus 11%; P<0.01). Conclusions In patients undergoing primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction, platelet reactivity in response to DAPT is a key predictor of the extent of both myocardial and microvascular damage. |
| first_indexed | 2024-03-11T11:15:22Z |
| format | Article |
| id | doaj.art-4998d13f41be45e0a8edc57cf30d7992 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-11T11:15:22Z |
| publishDate | 2022-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4998d13f41be45e0a8edc57cf30d79922023-11-11T04:49:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-02-0111310.1161/JAHA.121.020973Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance ImagingEias Massalha0Daniel Oren1Orly Goitein2Yafim Brodov3Alex Fardman4Anan Younis5Anat Berkovitch6Shir Raibman‐Spector7Eli Konen8Elad Maor9Paul Fefer10Amit Segev11Roy Beigel12Shlomi Matetzky13Sheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSackler School of Medicine Tel Aviv University Tel‐Aviv IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSackler School of Medicine Tel Aviv University Tel‐Aviv IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelSheba Medical Center Lev Leviev Heart, and Vascular Center Tel Hashomer IsraelBackground Despite optimized medical management and techniques of primary percutaneous coronary intervention, a substantial proportion of patients with ST‐segment–elevation myocardial infarction (STEMI) display significant microvascular damage. Thrombotic microvascular obstruction (MVO) has been implicated in the pathogenesis of microvascular and subsequent myocardial damage attributed to distal embolization and microvascular platelet plugging. However, there are only scarce data regarding the effect of platelet reactivity on MVO. Methods and Results We prospectively evaluated 105 patients in 2 distinct periods (2012–2013 and 2016–2018) who presented with first ST‐segment–elevation myocardial infarction and underwent primary percutaneous coronary intervention. All patients were treated with dual antiplatelet therapy (DAPT). Blood samples were analyzed for platelet reactivity, and cardiac magnetic resonance imaging scans were evaluated for late gadolinium enhancement and MVO. DAPT suboptimal response was defined as hyporesponsiveness to either aspirin or P2Y12 receptor inhibitor agents and demonstrated in 31 patients (29.5%) of the current cohort. Suboptimal platelet response to DAPT was associated with a significantly greater extent of MVO when expressed as a percentage of the left ventricular mass, left ventricular scar, and the number of myocardial left ventricular segments showing MVO (P<0.01 for each). Adjusted multivariable logistic regression model revealed that suboptimal response to DAPT is significantly associated with both greater late gadolinium enhancement (P<0.01) and MVO extent (odds ratio, 3.7 [95% CI, 1.3–10.5]; P=0.01). Patients with a greater extent of MVO were more likely to sustain major adverse cardiovascular events at a 1‐year follow‐up (37% versus 11%; P<0.01). Conclusions In patients undergoing primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction, platelet reactivity in response to DAPT is a key predictor of the extent of both myocardial and microvascular damage.https://www.ahajournals.org/doi/10.1161/JAHA.121.020973adenosine diphosphatearachidonic aciddual antiplatelet therapylate gadolinium enhancementmicrovascular obstructionplatelet aggregation |
| spellingShingle | Eias Massalha Daniel Oren Orly Goitein Yafim Brodov Alex Fardman Anan Younis Anat Berkovitch Shir Raibman‐Spector Eli Konen Elad Maor Paul Fefer Amit Segev Roy Beigel Shlomi Matetzky Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance Imaging Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adenosine diphosphate arachidonic acid dual antiplatelet therapy late gadolinium enhancement microvascular obstruction platelet aggregation |
| title | Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance Imaging |
| title_full | Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance Imaging |
| title_fullStr | Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance Imaging |
| title_full_unstemmed | Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance Imaging |
| title_short | Post–ST‐Segment–Elevation Myocardial Infarction Platelet Reactivity Is Associated With the Extent of Microvascular Obstruction and Infarct Size as Determined by Cardiac Magnetic Resonance Imaging |
| title_sort | post st segment elevation myocardial infarction platelet reactivity is associated with the extent of microvascular obstruction and infarct size as determined by cardiac magnetic resonance imaging |
| topic | adenosine diphosphate arachidonic acid dual antiplatelet therapy late gadolinium enhancement microvascular obstruction platelet aggregation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.020973 |
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