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The impact of high on-treatment platelet reactivity and fibrinogen levels on ischemic events in patients with ST elevation myocardial infarction: a prospective observational study

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Abstract

Background

After treatment, high residual platelet reactivity (HRPR) is considered as an essential risk factor for recurrent ischemic events.

Aim

To evaluate the impact of fibrinogen on HRPR after implantation of emergency drug-eluting stents (DES) in patients treated with aspirin and clopidogrel or ticagrelor due to ST-elevation myocardial infarction (STEMI) and to explore the predictive values of HRPR and fibrinogen for adverse ischemic events at 12 months.

Method

This single-center prospective observational study analyzed patients with STEMI who underwent primary percutaneous coronary intervention (PCI) with second-generation DES implantation from January 2017 to December 2018. Platelet reactivity was measured by thromboelastography (TEG) at 60–72 h after primary PCI. HRPR was defined as the adenosine diphosphate-induced maximum amplitude (MAADP) > 47 mm.

Results

A total of 919 patients were analyzed, of which 512 (55.8%) received aspirin and clopidogrel and 406 (44.2%) received aspirin and ticagrelor. Elevated fibrinogen levels were associated with an increased prevalence of HRPR (P < 0.001). High fibrinogen (quartile IV, ≥ 410 mg/dL) was an independent risk factor for HRPR after multivariate regression (odds ratio 6.556, 95% confidence interval [CI]: 3.200–13.431, P < 0.001). When analyzed by Kaplan–Meier survival curves, the combination of high fibrinogen and HRPR was strongly predictive for ischemic major adverse cardiac events at 12 months compared to the group without HRPR and with low fibrinogen (hazard ratio 9.681, 95% CI: 4.467–20.98, log-rank P < 0.001). Similar results were confirmed in subgroups according to different dual antiplatelet therapies.

Conclusion

A combination of high fibrinogen and HRPR may identify recurrent adverse ischemic events over 12 months. Ticagrelor exhibited more potent platelet inhibition and a better prognosis than clopidogrel.

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Acknowledgements

Shikun Xu and Qianzhou Lv contributed equally to this article as co-corresponding authors. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

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  1. Yao Yao and Xiaoye Li have contributed equally to this work.

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  1. Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China

    Yao Yao, Xiaoye Li, Zi Wang & Qianzhou Lv

  2. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China

    Shikun Xu

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Yao, Y., Li, X., Wang, Z. et al. The impact of high on-treatment platelet reactivity and fibrinogen levels on ischemic events in patients with ST elevation myocardial infarction: a prospective observational study. Int J Clin Pharm 45, 461–472 (2023). https://doi.org/10.1007/s11096-022-01525-1

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