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Platelet reactivity and coronary microvascular impairment after percutaneous revascularization in stable patients

Fabio Mangiacapra1, Mariano Pellicano2, Luigi Di Serafino2

  • 1Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy.

Atherosclerosis
|September 22, 2018
PubMed

Insights

Prasugrel significantly reduces platelet reactivity after percutaneous coronary intervention (PCI) compared to clopidogrel. This potent platelet inhibition may improve coronary microvascular function following PCI in patients with stable coronary artery disease.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Increased platelet reactivity (PR) and coronary microvascular impairment are observed in patients on clopidogrel post-PCI.
  • Prasugrel offers stronger platelet inhibition than clopidogrel, but its effect on PCI-related platelet activation is unclear.

Purpose of the Study:

  • To compare the effects of prasugrel versus clopidogrel on peri-procedural PR variations.
  • To assess the correlation between platelet inhibition potency and PCI-induced coronary microvascular impairment.

Main Methods:

  • Forty thienopyridine-naive patients were randomized to prasugrel (n=20) or clopidogrel (n=20) loading dose before elective PCI.
  • Adenosine diphosphate (ADP)-induced PR and the index of microvascular resistance (IMR) were measured at baseline and post-PCI.

Main Results:

  • ADP-induced PR was significantly lower in the prasugrel group versus the clopidogrel group at baseline and post-PCI (p < 0.001).
  • A peri-procedural increase in PR occurred with clopidogrel (p=0.008) but not with prasugrel (p=0.822).
  • A significant correlation was found between IMR and PR at baseline (r=0.458, p=0.003) and post-PCI (r=0.487, p=0.001).

Conclusions:

  • Prasugrel loading dose attenuates PCI-related PR increase compared to clopidogrel in stable CAD patients undergoing PCI.
  • This effect may contribute to prasugrel's benefit on peri-procedural coronary microvascular function.
Abstract

Keywords:
Antiplatelet agentsCoronary artery diseaseCoronary microvascular functionPlatelet reactivity

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