Abstract
Background
Spontaneous reperfusion, seen in ~20% of patients with ST-segment elevation myocardial infarction (STEMI), manifests as normal epicardial flow in the infarct-related artery (IRA), with or without ST-segment resolution, before percutaneous coronary intervention (PCI). The drivers mediating this are unknown.
Objectives
To relate spontaneous reperfusion to thrombotic profile.
Methods
In a prospective study, blood from STEMI patients (n=801) was tested pre-PCI to assess in vitro, point-of-care, occlusion (OT) and endogenous fibrinolysis (LT) times. Spontaneous reperfusion was defined as IRA TIMI III flow pre-PCI. Patients were followed for major cardiovascular events (MACE; death, myocardial infarction, stroke).
Results
Spontaneous reperfusion was associated with longer OT (435s vs. 366s, pConclusions
We demonstrate a novel haematological signature in STEMI patients with spontaneous reperfusion, namely reduced platelet reactivity and faster endogenous fibrinolysis, relating to smaller infarcts and improved survival. This indicates a role for modulating thrombotic status early following STEMI-onset, to facilitate spontaneous reperfusion and improve outcomes.
Spontaneous reperfusion, seen in ~20% of patients with ST-segment elevation myocardial infarction (STEMI), manifests as normal epicardial flow in the infarct-related artery (IRA), with or without ST-segment resolution, before percutaneous coronary intervention (PCI). The drivers mediating this are unknown.
Objectives
To relate spontaneous reperfusion to thrombotic profile.
Methods
In a prospective study, blood from STEMI patients (n=801) was tested pre-PCI to assess in vitro, point-of-care, occlusion (OT) and endogenous fibrinolysis (LT) times. Spontaneous reperfusion was defined as IRA TIMI III flow pre-PCI. Patients were followed for major cardiovascular events (MACE; death, myocardial infarction, stroke).
Results
Spontaneous reperfusion was associated with longer OT (435s vs. 366s, pConclusions
We demonstrate a novel haematological signature in STEMI patients with spontaneous reperfusion, namely reduced platelet reactivity and faster endogenous fibrinolysis, relating to smaller infarcts and improved survival. This indicates a role for modulating thrombotic status early following STEMI-onset, to facilitate spontaneous reperfusion and improve outcomes.
| Original language | English |
|---|---|
| Journal | Journal of the American College of Cardiology |
| Publication status | Accepted/In press - 1 Mar 2023 |