Residual platelet reactivity, thrombus burden and myocardial reperfusion in patients treated by PCI after successful pre-hospital fibrinolysis compared to primary PCI

J Thromb Thrombolysis. 2020 Nov;50(4):858-866. doi: 10.1007/s11239-020-02113-8.

Abstract

We compared residual platelet reactivity and post PCI atherothrombotic burden using OFDI in patients successfully treated by primary PCI versus pharmacoinvasive approach (PI) defined as PCI after successful pre-hospital fibrinolysis. Despite pre-hospital P2Y12-inhibitor loading dose, high rates of high on-treatment platelet reactivity were found at the time of PCI in both groups. Primary PCI patients had higher post stenting thrombus burden and lower rates of final normal myocardial blush grade compared to PI. These findings support the use of a pharmacoinvasive reperfusion strategy especially when primary PCI cannot be timely performed.

Keywords: Fibrinolysis; Platelet reactivity; Primary PCI; Rhrombus.

MeSH terms

  • Aged
  • Coronary Angiography / methods
  • Emergency Medical Services / methods
  • Female
  • Fibrinolytic Agents / therapeutic use
  • France / epidemiology
  • Humans
  • Male
  • Outcome and Process Assessment, Health Care
  • Percutaneous Coronary Intervention* / instrumentation
  • Percutaneous Coronary Intervention* / methods
  • Platelet Activation / drug effects*
  • Purinergic P2Y Receptor Antagonists / administration & dosage*
  • ST Elevation Myocardial Infarction* / blood
  • ST Elevation Myocardial Infarction* / diagnosis
  • ST Elevation Myocardial Infarction* / drug therapy
  • ST Elevation Myocardial Infarction* / surgery
  • Stents
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / methods
  • Thrombosis* / diagnostic imaging
  • Thrombosis* / pathology
  • Tomography, Optical Coherence / methods

Substances

  • Fibrinolytic Agents
  • Purinergic P2Y Receptor Antagonists