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Lower on-treatment platelet reactivity during everolimus-eluting stent implantation contributes to the resolution of post-procedural intra-stent thrombus: serial OCT observation in the PRASFIT-Elective study

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Abstract

Intra-stent thrombus (IS-Th) formed immediately after percutaneous coronary intervention (PCI) is associated with subsequent adverse coronary events. However, the impact of on-treatment platelet reactivity on IS-Th is unknown. PRASFIT-Elective is a multicenter study of PCI patients receiving prasugrel (20/3.75 mg, loading/maintenance dose) or clopidogrel (300/75 mg), with aspirin (100 mg). Among the 742 study patients, 111 were pre-specified for the OCT sub-study. Of these, 82 underwent OCT immediately after PCI to assess IS-Th and at an 8-month follow-up to evaluate the fate of the IS-Th. Lesions were considered resolved when IS-Th were detected after PCI but not on the follow-up or persistent when IS-Th were observed on both scans. The P2Y12 Reactive Unit (PRU) value was determined at the initial PCI and 4 and 48 weeks post-PCI. In 76 patients (86 lesions), we detected 230 IS-Th initially, and 196 IS-Th (85.2%) were resolved at the 8-month OCT. At PCI, but not 4 or 48 weeks after, the resolved IS-Th group had a lower PRU than the persistent IS-Th group (199 ± 101 vs. 266 ± 102, p = 0.008). Multivariate logistic regression analyses revealed that lower PRU at PCI and less calcified lesions were independent predictive factors for the resolution of IS-Th. Local lesion-related factors and lower on-treatment platelet reactivity at the time of PCI may contribute to the resolution of IS-Th after EES implantation, potentially improving clinical outcome.

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Abbreviations

IS-Th:

Intra-stent thrombus

PRU:

P2Y12 reaction unit

DES:

Drug-eluting stent

EES:

Everolimus-eluting stent

BMS:

Bare metal stent

SES:

Sirolimus-eluting stent

PES:

Paclitaxel-eluting stent

OCT:

Optical coherence tomography

AIT:

Abnormal intra-luminal tissue

PCI:

Percutaneous coronary intervention

LD:

Loading dose

MD:

Maintenance dose

ACS:

Acute coronary syndrome

CAD:

Coronary artery disease

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Acknowledgements

The authors deeply appreciate the contributions of all the investigators and other clinical/research staff involved in the present study.

Funding

This study was sponsored by Daiichi Sankyo (Tokyo, Japan).

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan

    Akihide Konishi, Masamichi Iwasaki, Toshiro Shinke, Hiromasa Otake, Masayuki Nakagawa, Hirotoshi Hariki, Tsuyoshi Osue, Takumi Inoue, Yu Taniguchi, Ryo Nishio, Hiroto Kinutani, Noritoshi Hiranuma, Masaru Kuroda & Ken-ichi Hirata

  2. Division of Cardiology, Shonan Kamamura General Hospital, Kamakura, Japan

    Shigeru Saito

  3. Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan

    Masato Nakamura

  4. Division of Cardiology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan

    Junya Shite

  5. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan

    Takashi Akasaka

  6. Department of Cardiology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Toshiro Shinke

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  1. Akihide Konishi
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  2. Masamichi Iwasaki
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  4. Hiromasa Otake
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  9. Yu Taniguchi
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  13. Masaru Kuroda
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  16. Masato Nakamura
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Correspondence to Toshiro Shinke.

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Conflict of interest

The authors declare the following interests: Shigeru Saito is a medical advisor for Terumo and has received honoraria from Abbot Vascular Japan, Boston Scientific Japan, and Medtronic; Masato Nakamura has received honoraria from Daiichi Sankyo, Sanofi, and AstraZeneca; Junya Shite has received honoraria from Goodman and St. Jude Medical Japan; Takashi Akasaka has received honoraria from Abbot Vascular Japan, Goodman, St Jude Medical Japan, Terumo, and Daiichi-Sankyo, research grants from Abbot Vascular Japan, Boston Scientific Japan, Daiichi-Sankyo, Goodman, St Jude Medical Japan, and Terumo.

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Konishi, A., Iwasaki, M., Shinke, T. et al. Lower on-treatment platelet reactivity during everolimus-eluting stent implantation contributes to the resolution of post-procedural intra-stent thrombus: serial OCT observation in the PRASFIT-Elective study. Heart Vessels 33, 1423–1433 (2018). https://doi.org/10.1007/s00380-018-1195-4

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