P2Y12 receptor inhibition and effect of morphine in patients undergoing primary PCI for ST-segment elevation myocardial infarction

Johanne Silvain; Robert F. Storey; Guillaume Cayla; Jean-Baptiste Esteve; Jean-Guillaume Dillinger; Hélène Rousseau; Anne Tsatsaris; Caroline Baradat; Néjoua Salhi; Christian W. Hamm; Frédéric Lapostolle; Jens Flensted Lassen; Jean-Philippe Collet; Jurrien M. ten Berg; Arnoud W. van ’t Hof; Gilles Montalescot

doi:10.1160/TH15-12-0944

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2016; 116(02): 369-378
DOI: 10.1160/TH15-12-0944

Atherosclerosis and Ischaemic Disease

Schattauer GmbH

P2Y₁₂ receptor inhibition and effect of morphine in patients undergoing primary PCI for ST-segment elevation myocardial infarction

The PRIVATE-ATLANTIC study^[*]

Autoren

Johanne Silvain

¹Université Paris 06, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtriere University Hospital (AP-HP) - Paris, France
Robert F. Storey

²Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
Guillaume Cayla

³Service de Cardiology, CHU Caremeau, Nîmes, France
Jean-Baptiste Esteve

⁴CHU de la Réunion, Réunion - Le Raincy-Montfermeil, Montfermeil, France
Jean-Guillaume Dillinger

⁵Department of Cardiology, INSERM U942, Hôpital Lariboisière, AP-HP, Paris Diderot University, Paris, France
Hélène Rousseau

⁶Unité de Recherche Clinique, Hôpital Lariboisière, Paris, France
Anne Tsatsaris

⁷AstraZeneca, Rueil Malmaison, France
Caroline Baradat

⁷AstraZeneca, Rueil Malmaison, France
Néjoua Salhi

⁸AstraZeneca, Luton, United Kingdom
Christian W. Hamm

⁹Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
Frédéric Lapostolle

¹⁰SAMU 93, Hôpital Avicenne, Bobigny, France
Jens Flensted Lassen

¹¹Department of Cardiology B, Aarhus University Hospital, Skejby, Aarhus N, Denmark
Jean-Philippe Collet

¹Université Paris 06, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtriere University Hospital (AP-HP) - Paris, France
Jurrien M. ten Berg

¹²Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
Arnoud W. van ’t Hof

¹³Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
Gilles Montalescot

¹Université Paris 06, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtriere University Hospital (AP-HP) - Paris, France

Abstract

Summary

PRIVATE-ATLANTIC (P2Y₁₂ Receptor Inhibition with VASP Testing using Elisa kit during the ATLANTIC study) is a pre-specified substudy of the randomised, double-blind ATLANTIC trial in patients with ST-segment elevation myocardial infarction, designed to help interpret the main trial results. The primary objective of ATLANTIC was to assess coronary reperfusion prior to percutaneous coronary intervention (PCI) with pre- vs in-hospital ticagrelor 180 mg loading dose (LD). PRIVATE-ATLANTIC assessed platelet inhibition in 37 patients by measurement of vasodilator-associated stimulated phosphoprotein (VASP) platelet reactivity index (PRI) and VerifyNow platelet reactivity units (PRU) before angiogram (T1), immediately after PCI (T2), 1 (T3), and 6 (T4) hours (h) after PCI, and before next study drug administration (T5). The median time difference between the two ticagrelor LD was 41 minutes. Platelet reactivity was unaffected at T1 when measured by VASP-PRI (89.8 vs 93.9% for pre- and in-hospital ticagrelor, respectively; p = 0.18) or PRU (239 vs 241; p = 0.82). Numerical differences were apparent at T2 and maximal at T3. Morphine administration significantly delayed onset of platelet inhibition at T3 (VASP-PRI 78.2 vs 23.4% without morphine; p = 0.0116) and T4 (33.1 vs 11.0%; p = 0.0057). In conclusion, platelet inhibition in ATLANTIC was unaffected by pre-hospital ticagrelor administration at the time of initial angiogram due to the short transfer delay. The maximum difference in platelet inhibition was detected 1 h after PCI (T3). Morphine administration was associated with delayed onset of action of ticagrelor and appeared more important than timing of ticagrelor administration.

Keywords

Ticagrelor - platelet reactivity - morphine - STEMI - PCI

Volltext

Referenzen

References
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