Skip to main content

Advertisement

SpringerLink
Log in

Myocardial salvage after ST-segment-elevation myocardial infarction: comparison between prasugrel and clopidogrel in the presence or absence of high-residual platelet reactivity

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The effect of prasugrel over clopidogrel on myocardial salvage in ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI) is not fully elucidated.

Methods

Among 854 consecutive STEMI patients who underwent p-PCI, 446 patients were evaluated by two-phase (7 days and 3 months) single-photo emission computed tomography (SPECT). Patients were divided into two groups based on the loading P2Y12 inhibitor. The clopidogrel group was further divided based on the result of platelet function testing. Thus, the prasugrel group included 227 patients; the clopidogrel without high-residual platelet reactivity (HRPR) group, 109 patients; and the clopidogrel with HRPR group, 107 patients. The primary endpoint was the Myocardial Salvage Index (MSI), determined by SPECT.

Results

The incidence of final TIMI 0/1 and TIMI myocardial perfusion grade 0/1 was higher in the clopidogrel with HRPR group (0.9%, 1.8%, and 7.5%, P =  .002; 19.8%, 29.4%, and 41.1%, P = .0002, in the prasugrel, clopidogrel without HRPR, and clopidogrel with HRPR groups, respectively). The MSI was significantly lower in the clopidogrel with HRPR group (48% [27-66], 44% [30-72], and 36% [15-55], P =  .006, respectively).

Conclusions

Prasugrel in STEMI patients was associated with an increased MSI compared with clopidogrel in the presence of HRPR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

Abbreviations

AAR:

Area at risk

BMIPP:

123I-beta-methyl-p-iodophenyl pentadecanoic acid

HRPR:

High-residual platelet reactivity

MSI:

Myocardial Salvage Index

PFT:

Platelet function testing

p-PCI:

Primary percutaneous coronary intervention

SPECT:

Single-photo emission computed tomography

STEMI:

ST-segment-elevation myocardial infarction

Tc:

99mTechnetium

TPD:

Total perfusion deficit

References

  1. Gurbel PA, Bliden KP, Hiatt BL, O’Connor CM. Clopidogrel for coronary stenting: Response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003;107:2908-13.

    Article  Google Scholar 

  2. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007;357:2001-15.

    Article  CAS  Google Scholar 

  3. Bonaca MP, Wiviott SD, Braunwald E, Murphy SA, Ruff CT, Antman EM, et al. American College of Cardiology/American Heart Association/European Society of Cardiology/World Heart Federation universal definition of myocardial infarction classification system and the risk of cardiovascular death: Observations from the TRITON-TIMI 38 trial (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel-Thrombolysis in Myocardial Infarction 38). Circulation 2012;125:577-83.

    Article  Google Scholar 

  4. Baber U, Sartori S, Aquino M, Kini A, Kapadia S, Weiss S, et al. Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study. Am Heart J 2017;188:73-81.

    Article  CAS  Google Scholar 

  5. Danchin N, Lettino M, Zeymer U, Widimsky P, Bardaji A, Barrabes JA, et al. Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries. Eur Heart J Cardiovasc Pharmacother 2016;2:152-67.

    Article  Google Scholar 

  6. Kim K, Lee TA, Touchette DR, DiDomenico RJ, Ardati AK, Walton SM. Contemporary trends in oral antiplatelet agent use in patients treated with percutaneous coronary intervention for acute coronary syndrome. J Manag Care Spec Pharm 2017;23:57-63.

    PubMed  Google Scholar 

  7. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019;40:237-69.

    Article  Google Scholar 

  8. Ishihara M, Asakura M, Kimura K, Nakao K, Hamada C, Hirayama A. Trial design and rationale of TY-51924 as a novel Na+/H+ exchanger inhibitor in patients with ST-elevation acute myocardial infarction undergoing percutaneous coronary intervention. J Cardiol 2014;63:82-7.

    Article  Google Scholar 

  9. Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, et al. Cytochrome P450 genetic polymorphisms and the response to prasugrel: Relationship to pharmacokinetic, pharmacodynamic, and clinical outcomes. Circulation 2009;119:2553-60.

    Article  CAS  Google Scholar 

  10. Nakamura M, Iizuka T, Sagawa K, Abe K, Chikada S, Arai M. Prasugrel for Japanese patients with acute coronary syndrome in short-term clinical practice (PRASFIT-Practice I): A postmarketing observational study. Cardiovasc Interv Ther 2018;33:135-45.

    Article  CAS  Google Scholar 

  11. Kim JS, Kim J, Choi D, Lee CJ, Lee SH, Ko YG, et al. Efficacy of high-dose atorvastatin loading before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The STATIN STEMI trial. JACC Cardiovasc Interv 2010;3:332-9.

    Article  Google Scholar 

  12. Group TS. The thrombolysis in myocardial infarction (TIMI) trial Phase I findings. N Engl J Med 1985;312:932-6.

    Google Scholar 

  13. Gibson CM, Cannon CP, Murphy SA, Ryan KA, Mesley R, Marble SJ, et al. Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs. Circulation 2000;101:125-30.

    Article  CAS  Google Scholar 

  14. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H, et al. Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 2000;36:1202-9.

    Article  CAS  Google Scholar 

  15. Slomka PJ, Nishina H, Berman DS, Akincioglu C, Abidov A, Friedman JD, et al. Automated quantification of myocardial perfusion SPECT using simplified normal limits. J Nucl Cardiol 2005;12:66-77.

    Article  Google Scholar 

  16. Nakajima K. Normal values for nuclear cardiology: Japanese databases for myocardial perfusion, fatty acid and sympathetic imaging and left ventricular function. Ann Nucl Med 2010;24:125-35.

    Article  Google Scholar 

  17. Ozeki Y, Sudo T, Toga K, Nagamura Y, Ito H, Ogawa T, et al. Characterization of whole blood aggregation with a new type of aggregometer by a screen filtration pressure method. Thromb Res 2001;101:65-72.

    Article  CAS  Google Scholar 

  18. Nagashima Z, Tsukahara K, Morita S, Endo T, Sugano T, Hibi K, et al. Platelet reactivity in the early and late phases of acute coronary syndromes according to cytochrome P450 2C19 phenotypes. J Cardiol 2013;62:158-64.

    Article  Google Scholar 

  19. Yamamoto K, Hokimoto S, Chitose T, Morita K, Ono T, Kaikita K, et al. Impact of CYP2C19 polymorphism on residual platelet reactivity in patients with coronary heart disease during antiplatelet therapy. J Cardiol 2011;57:194-201.

    Article  Google Scholar 

  20. Holm S. A simple sequentially rejective multiple test procedure. Scand J Stat 1979;6:65-70.

    Google Scholar 

  21. Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): Double-blind, randomised controlled trial. Lancet 2009;373:723-31.

    Article  CAS  Google Scholar 

  22. Chin CT, Wang TY, Anstrom KJ, Zhu B, Maa JF, Messenger JC, et al. Treatment with adenosine diphosphate receptor inhibitors-longitudinal assessment of treatment patterns and events after acute coronary syndrome (TRANSLATE-ACS) study design: Expanding the paradigm of longitudinal observational research. Am Heart J 2011;162:844-51.

    Article  CAS  Google Scholar 

  23. Steinhubl SR, Lauer MS, Mukherjee DP, Moliterno DJ, Lincoff AM, Ellis SG, et al. The duration of pretreatment with ticlopidine prior to stenting is associated with the risk of procedure-related non-Q-wave myocardial infarctions. J Am Coll Cardiol 1998;32:1366-70.

    Article  CAS  Google Scholar 

  24. Ishii H, Amano T, Matsubara T, Murohara T. Pharmacological intervention for prevention of left ventricular remodeling and improving prognosis in myocardial infarction. Circulation 2008;118:2710-8.

    Article  Google Scholar 

  25. Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: A randomized controlled trial. JAMA 2002;288:2411-20.

    Article  CAS  Google Scholar 

  26. Brandt JT, Payne CD, Wiviott SD, Weerakkody G, Farid NA, Small DS, et al. A comparison of prasugrel and clopidogrel loading doses on platelet function: Magnitude of platelet inhibition is related to active metabolite formation. Am Heart J 2007;153(66):e69-76.

    Google Scholar 

  27. Mega JL, Close SL, Wiviott SD, Shen L, Hockett RD, Brandt JT, et al. Cytochrome p-450 polymorphisms and response to clopidogrel. N Engl J Med 2009;360:354-62.

    Article  CAS  Google Scholar 

  28. Yoshinaga K, Naya M, Shiga T, Suzuki E, Tamaki N. Ischaemic memory imaging using metabolic radiopharmaceuticals: Overview of clinical settings and ongoing investigations. Eur J Nucl Med Mol Imaging 2014;41:384-93.

    Article  CAS  Google Scholar 

  29. Kawai Y, Tsukamoto E, Nozaki Y, Kishino K, Kohya T, Tamaki N. Use of 123I-BMIPP single-photon emission tomography to estimate areas at risk following successful revascularization in patients with acute myocardial infarction. Eur J Nucl Med 1998;25:1390-5.

    Article  CAS  Google Scholar 

  30. Tanaka R, Nakamura T. Time course evaluation of myocardial perfusion after reperfusion therapy by 99mTc-tetrofosmin SPECT in patients with acute myocardial infarction. J Nucl Med 2001;42:1351-8.

    CAS  PubMed  Google Scholar 

  31. Mori H, Isobe S, Sakai S, Yamada T, Watanabe N, Miura M, et al. Microvascular obstruction on delayed enhancement cardiac magnetic resonance imaging after acute myocardial infarction, compared with myocardial (201)Tl and (123)I-BMIPP dual SPECT findings. Eur J Radiol 2015;84:1516-24.

    Article  Google Scholar 

  32. Suzuki N, Hiasa Y, Takahashi T, Chen H, Miyazaki S, Mahara K, et al. Early prediction of myocardial salvage after primary coronary angioplasty: Comparative study of coronary flow velocity pattern immediately after primary coronary angioplasty and perfusion-metabolism mismatch. J Cardiol 2007;49:163-70.

    PubMed  Google Scholar 

  33. Saito S, Isshiki T, Kimura T, Ogawa H, Yokoi H, Nanto S, et al. Efficacy and safety of adjusted-dose prasugrel compared with clopidogrel in Japanese patients with acute coronary syndrome: The PRASFIT-ACS study. Circ J 2014;78:1684-92.

    Article  CAS  Google Scholar 

  34. Ellis SG, Brener SJ, Lincoff AM, Moliterno DJ, Whitlow PL, Schneider JP, et al. beta-blockers before percutaneous coronary intervention do not attenuate postprocedural creatine kinase isoenzyme rise. Circulation 2001;104:2685-8.

    Article  CAS  Google Scholar 

  35. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: The CAPRICORN randomised trial. Lancet 2001;357:1385-90.

    Article  CAS  Google Scholar 

  36. Bhindi R, Kajander OA, Jolly SS, Kassam S, Lavi S, Niemela K, et al. Culprit lesion thrombus burden after manual thrombectomy or percutaneous coronary intervention-alone in ST-segment elevation myocardial infarction: The optical coherence tomography sub-study of the TOTAL (ThrOmbecTomy versus PCI ALone) trial. Eur Heart J 2015;36:1892-900.

    Article  Google Scholar 

  37. Onuma Y, Thuesen L, van Geuns RJ, van der Ent M, Desch S, Fajadet J, et al. Randomized study to assess the effect of thrombus aspiration on flow area in patients with ST-elevation myocardial infarction: An optical frequency domain imaging study—TROFI trial. Eur Heart J 2013;34:1050-60.

    Article  CAS  Google Scholar 

  38. Jolly SS, Cairns JA, Yusuf S, Meeks B, Pogue J, Rokoss MJ, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015;372:1389-98.

    Article  CAS  Google Scholar 

  39. Patel MR, Smalling RW, Thiele H, Barnhart HX, Zhou Y, Chandra P, et al. Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: The CRISP AMI randomized trial. JAMA 2011;306:1329-37.

    Article  CAS  Google Scholar 

Download references

Disclosures

Dr. Ishii received lecture fees from Astellas Pharma Inc., Bayer Pharmaceutical Co., Ltd., Daiichi-Sankyo Pharma Inc., and MSD K. K. Dr. Murohara received lecture fees from Bayer Yakuhin., Ltd., Daiichi-Sankyo Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd. Dr. Yoshida, Takagi, Morishima, Tanaka, Morita, Kanzaki, Nagai, Watanabe, Furui, Shibata, Yoshioka, Yamauchi, Komeyama, Sugiyama, and Tsuboi have nothing to disclose.

Author information

Authors and Affiliations

  1. Department of Cardiology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan

    Ruka Yoshida MD, Akihito Tanaka MD, PhD & Naoki Shibata MD

  2. Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan

    Ruka Yoshida MD, Kensuke Takagi MD, Itsuro Morishima MD, PhD, Yasuhiro Morita MD, PhD, Yasunori Kanzaki MD, Hiroaki Nagai MD, Naoki Watanabe MD, PhD, Koichi Furui MD, Naoki Shibata MD, Naoki Yoshioka MD, Ryota Yamauchi MD, Shotaro Komeyama MD, Hiroki Sugiyama MD & Hideyuki Tsuboi MD, PhD

  3. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Hideki Ishii MD, PhD, Koichi Furui MD & Toyoaki Murohara MD, PhD

Authors
  1. Ruka Yoshida MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kensuke Takagi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hideki Ishii MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Itsuro Morishima MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akihito Tanaka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yasuhiro Morita MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasunori Kanzaki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hiroaki Nagai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Naoki Watanabe MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koichi Furui MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Naoki Shibata MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Naoki Yoshioka MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ryota Yamauchi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Shotaro Komeyama MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Hiroki Sugiyama MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Hideyuki Tsuboi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Toyoaki Murohara MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruka Yoshida MD.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

Funding

This work was not supported by any funding. Department of Cardiology, Nagoya University Graduate School of Medicine received research Grant from Astellas Pharma Inc., Daiichi-Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Kowa Co., Ltd., MSD K. K., Mitsubishi Tanabe Pharma Co., Nippon Boehringer Ingelheim Co., Ltd., Pfizer Japan Inc., and Teijin Pharma Ltd.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 24 kb)

Supplementary material 2 (PPTX 2012 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yoshida, R., Takagi, K., Ishii, H. et al. Myocardial salvage after ST-segment-elevation myocardial infarction: comparison between prasugrel and clopidogrel in the presence or absence of high-residual platelet reactivity. J. Nucl. Cardiol. 28, 1422–1434 (2021). https://doi.org/10.1007/s12350-019-01852-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-019-01852-3

Keywords

Search

Navigation