Myocardial Infarction, Thrombosis, Coronary
Conditions
Keywords
myocardial infarction, optical coherence tomography, intracoronary thrombus, VerifyNow
Brief summary
The management of ST-elevation myocardial infarction in the acute phase requires an optimal antiaggregation combining aspirin and a P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor). Primary percutaneous coronary intervention must be performed within 2 hours of first medical contact. However, even with the new P2Y12 inhibitors, effective platelet inhibition which is required to inhibit the progression of intracoronary thrombus, is present only in half of the patients at 2 hours. Optical coherence tomography (OCT) is the reference method for visualizing and quantifying intracoronary thrombus. The post-stenting intracoronary residual mass evaluated in OCT was associated with altered myocardial reperfusion indices, which were themselves associated with the prognosis of the patient. However, the determinants of this post-stenting residual mass -mostly thrombotic- remain unknown. Measurement of platelet reactivity (expressed as P2Y12 Reaction Unit and Aspirin Reaction Unit) by simple turbidimetric tests (VerifyNow) is available in the cathlab. Enhanced platelet reactivity is reported in patients with acute coronary syndrome and represents a high-risk situation for recurrent coronary events in this setting. The study aims to: 1. to evaluate the relationship between the post-stenting residual intracoronary mass evaluated in OCT and the platelet response at the time of the PCI evaluated by Verify Now 2. to confirm the impact of the residual mass measured by OCT on the EKG and angiographic myocardial reperfusion indices 3. identify patients with high thrombotic risk who may require more intensive antithrombotic therapy 4. identify simple biological markers associated with the residual mass measured by OCT
Interventions
DIAGNOSTIC_TESToptical coherence tomography and VerifyNow
optical coherence tomography Imaging P2Y12 and Aspirin reaction units quantification by the VerifyNow
Sponsors
University Hospital, Caen
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* primary PCI with successful stenting for ST-elevation myocardial infarction * pretreated with ticagrelor, aspirin and enoxaparin * OCT and verifyNow performed in the acute phase
Exclusion criteria
* stent thrombosis * known coagulation disorder * clinical instability * pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the volume of residual intrastent mass measured by OCT | day 0 | volume of the residual mass in mm3 |
| the platelet reactivity assessed by VerifyNow | day 0 | P2Y12 and aspirin reaction units, assessed by VerifyNow |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Myocardial blush grade | day 0 | Blush grade (from 0= no blush; 1=minimal; 2=moderate to 3= normal blush) assessed on angiography after angioplasty |
| angiographic pre-stenting thrombus grade | day 0 | angiographic thrombus grade score (from 0=no thrombus to 5=occlusive thrombus) |
| regression of EKG ST-segment elevation | day 0 | regression of ST-segment elevation \>50% after angioplasty |
| fibrinogen | day 0 | biological marker (in g/L) |
| albumin | day 0 | biological marker (in g/L) |
| troponin | day 0 | biological marker (µg/L) |
| Corrected Timi Frame count | day 0 | TIMI frame count (number) assessed after angioplasty |
Countries
France
Outcome results
None listed