Potent effect of prasugrel on acute phase resolution of intra-stent athero-thrombotic burden after percutaneous intervention to acute coronary syndrome.

Abstract

BACKGROUND:

Recent studies suggested protruding thrombus and atheroma after stent placement could be a substrate for subsequent adverse ischemic events. Although protruded atherothrombotic burden can be assessed as intra-stent tissue (IST) by optical coherence tomography (OCT), the effects of potent antiplatelet therapy on the acute phase resolution of IST in patients with acute coronary syndrome (ACS) was unknown.

METHODS:

Ninety-six consecutive ACS patients with multi-vessel disease were enrolled in this prospective registry. In combination with aspirin, either clopidogrel or prasugrel was selected according to the date of enrolment. OCT examination was done immediately after percutaneous coronary intervention (post-PCI) and 10 days after index PCI (follow-up acute phase) to calculate averaged IST score as semi-quantitative measures of IST. High residual platelet reactivity (HRPR) was defined as platelet reactivity units (PRU)≥240 by VerifyNow P2Y12 assay (Accumetrics Inc., San Diego, CA, USA).

RESULTS:

Thirty two patients (38 stents) were enrolled in the prasugrel group and sixty four patients (72 stents) in the clopidogrel group. Averaged IST scores post-PCI were similar between the two groups (0.68±0.41 vs. 0.68±0.40, p=0.99), which decreased in all of the prasugrel group and in 87.5% of the clopidogrel group (p=0.02). Consequently, changes in averaged IST score (delta averaged IST score) were significantly greater in the prasugrel group compared to those in the clopidogrel group (-0.411±0.288 vs. -0.299±0.270, p=0.045). The frequency of HRPR was significantly lower in the prasugrel group (10.0% vs 32.4%, p=0.028).

CONCLUSIONS:

Prasugrel plus aspirin achieved greater acute phase reduction of IST than clopidogrel plus aspirin, which might underlie the clinical benefit of potent antiplatelet therapy in ACS. (UMIN000018751).

• Authors: Yoshiro Tsukiyama, Amane Kozuki, Toshiro Shinke, Hiromasa Otake, Yoichi Kijima, Tomoya Masano, Ryoji Nagoshi, Hiroyuki Shibata, Ryo Takeshige, Ken-Ichi Yanaka, Junya Shite, Ken-Ichi Hirata
• Journal: Journal of cardiology (J Cardiol) Vol. 72 Issue 5 Pg. 403-410 (11 2018) ISSN: 1876-4738 [Electronic] Netherlands
• PMID: 29731189 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2018. Published by Elsevier Ltd.

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Prasugrel Hydrochloride
• Aspirin

Topics

• Acute Coronary Syndrome (physiopathology, surgery)
• Aged
• Aspirin (therapeutic use)
• Blood Platelets (drug effects)
• Clopidogrel (therapeutic use)
• Drug Therapy, Combination
• Female
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects)
• Plaque, Atherosclerotic (drug therapy, etiology)
• Platelet Aggregation Inhibitors (therapeutic use)
• Postoperative Complications (drug therapy, etiology)
• Prasugrel Hydrochloride (therapeutic use)
• Prospective Studies
• Registries
• Stents (adverse effects)
• Thrombosis (drug therapy, etiology)
• Tomography, Optical Coherence
• Treatment Outcome