Findings Published From PRESTIGE Registry Evaluating High Platelet Reactivity
December 21, 2017—Results from the PRESTIGE registry were published by Thea C. Godschalk, MSc, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2017;10:2548–2556). PRESTIGE investigated high platelet reactivity (HPR) in patients presenting with ST-segment elevation myocardial infarction (STEMI) caused by stent thrombosis undergoing immediate percutaneous coronary intervention (PCI).
The background of the study is that HPR on P2Y12 inhibitors (HPR-ADP) is frequently observed in stable patients who have experienced stent thrombosis, but that the HPR rates in patients presenting with stent thrombosis for immediate PCI are unknown.
As summarized in JACC: Cardiovascular Interventions, the multicenter PRESTIGE registry included consecutive patients presenting with definite stent thrombosis. Platelet reactivity was measured with the VerifyNow P2Y12 or Aspirin assay (Accriva Diagnostics, representing ITC and Accumetrics) in 129 stent thrombosis patients presenting with STEMI before undergoing immediate PCI.
The investigators reported that HPR-ADP was observed in 76% of the patients, and HPR on aspirin (HPR-AA) was observed in 13% of the patients. HPR rates were similar in patients who were on maintenance P2Y12 inhibitors or aspirin since stent placement versus those without these medications. In addition, HPR-ADP was similar in patients loaded with a P2Y12 inhibitor shortly before immediate PCI versus those who were not. In contrast, HPR-AA trended to be lower in patients loaded with aspirin as compared with those not loaded.
The investigators concluded that approximately three of four stent thrombosis patients with STEMI undergoing immediate PCI had HPR-ADP, and 13% had HPR-AA. HPR rates were not influenced by whether patients were on maintenance antiplatelet therapy while developing stent thrombosis or loaded with P2Y12 inhibitors shortly before undergoing immediate PCI. These findings raise concerns that the majority of patients with stent thrombosis have suboptimal platelet inhibition undergoing immediate PCI, advised the investigators in JACC: Cardiovascular Interventions.