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Post–ST‐segment–elevation myocardial infarction platelet reactivity is associated with the extent of microvascular obstruction and infarct size as determined by cardiac magnetic resonance imaging

Journal of the American Heart AssociationMassalha E, Oren D, Goitein O, et al. | January 22, 2022


Despite optimized medical management and techniques of primary percutaneous coronary intervention, significant microvascular damage affects a substantial proportion of patients with ST‐segment–elevation myocardial infarction (STEMI). Given the implications of thrombotic microvascular obstruction (MVO) in the pathogenesis of microvascular and subsequent myocardial damage attributing to distal embolization and microvascular platelet plugging, researchers herein sought for data concerning the effect of platelet reactivity on MVO.

  • A total of 105 patients were evaluated in 2 distinct periods (2012–2013 and 2016–2018) who presented with the first ST‐segment–elevation myocardial infarction and underwent primary percutaneous coronary intervention.

  • Dual antiplatelet therapy (DAPT) was provided to all the patients.

  • Hyporesponsiveness to either aspirin or P2Y12 receptor inhibitor agents was defined as DAPT suboptimal response and demonstrated in 31 patients (29.5%) of the current cohort.

  • In adjusted multivariable logistic regression model, suboptimal response to DAPT is noted to be significantly linked with both greater late gadolinium enhancement and MVO extent.

  • Patients with a greater extent of MVO more frequently experienced major adverse cardiovascular events at a 1‐year follow‐up (37% vs 11%).

  • Platelet reactivity in response to DAPT is identified to be a key predictor of the extent of both myocardial and microvascular damage in patients undergoing primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction.