Skip to main content
SpringerLink
Log in

Impact of antiplatelet therapy on tissue prolapse at super acute phase after stenting: serial OCT study in acute coronary syndrome patients

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Although drug-eluting stents have improved clinical outcomes, percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains a challenging procedure in terms of thrombus management. A new-generation P2Y12 receptor inhibitor, prasugrel, provides more rapid and potent antiplatelet action compared with clopidogrel. Prasugrel achieved significant reduction of ischemic events compared with clopidogrel in ACS. The aim of this optical coherence tomography (OCT) study was to evaluate temporal changes in tissue prolapse after stenting under different antiplatelet regimens (aspirin plus prasugrel or clopidogrel) in ACS patients. A total of 119 ACS patients were randomized to either prasugrel or clopidogrel at the time of PCI. OCT analysis was available in 119 patients at baseline (just after stenting), 77 patients at 2 weeks, and 62 patients at 4 months after stenting. Cross-sectional analysis for every 1 mm was performed at in-stent and adjacent reference segment. Tissue prolapse area was calculated by lumen area minus stent area within the stented segment. Baseline patient and procedural characteristics were not different between the prasugrel and clopidogrel groups. Tissue prolapse area was significantly lower in the prasugrel compared with the clopidogrel group after stenting (0.24 ± 0.23 vs. 0.36 ± 0.23 mm2, p = 0.003) and at 2 weeks (0.11 ± 0.13 vs. 0.19 ± 0.16 mm2, p = 0.005). However, there was no significant difference at 4 months. In conclusion, our study suggests prasugrel was effective in reducing tissue prolapse in the super acute phase in ACS patients compared with clopidogrel. However, the effect of tissue prolapse reduction was not different up to 4 months follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA, Granger CB, Lange RA, Mack MJ, Mauri L, Mehran R, Mukherjee D, Newby LK, O'Gara PT, Sabatine MS, Smith PK, Smith SC Jr (2016) 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation 134:e123–155

    Article  Google Scholar 

  2. Saito S, Isshiki T, Kimura T, Ogawa H, Yokoi H, Nanto S, Takayama M, Kitagawa K, Nishikawa M, Miyazaki S, Nakamura M (2014) Efficacy and safety of adjusted-dose prasugrel compared with clopidogrel in Japanese patients with acute coronary syndrome: the PRASFIT-ACS study. Circ J 78:1684–1692

    Article  CAS  Google Scholar 

  3. Steinhubl SR, Berger PB, Mann JT 3rd, Fry ET, DeLago A, Wilmer C, Topol EJ, Investigators C (2002) Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 288:2411–2420

    Article  CAS  Google Scholar 

  4. Jang IK, Bouma BE, Kang DH, Park SJ, Park SW, Seung KB, Choi KB, Shishkov M, Schlendorf K, Pomerantsev E, Houser SL, Aretz HT, Tearney GJ (2002) Visualization of coronary atherosclerotic plaques in patients using optical coherence tomography: comparison with intravascular ultrasound. J Am Coll Cardiol 39:604–609

    Article  Google Scholar 

  5. Kubo T, Akasaka T, Shite J, Suzuki T, Uemura S, Yu B, Kozuma K, Kitabata H, Shinke T, Habara M, Saito Y, Hou J, Suzuki N, Zhang S (2013) OCT compared with IVUS in a coronary lesion assessment: the OPUS-CLASS study. J Am Coll Cardiol Img 6:1095–1104

    Article  Google Scholar 

  6. Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, Otsuji S, Ueno T, Shiode N, Kawai K, Tanaka N, Ueda K, Akasaka T, Hanaoka KI, Uemura S, Oda H, Katahira Y, Kadota K, Kyo E, Sato K, Sato T, Shite J, Nakao K, Nishino M, Hikichi Y, Honye J, Matsubara T, Mizuno S, Muramatsu T, Inohara T, Kohsaka S, Michishita I, Yokoi H, Serruys PW, Ikari Y, Nakamura M, Task Force on Primary Percutaneous Coronary Intervention of the Japanese Cardiovascular Interventional T (2018) CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther 33:178–203

  7. Shimoda M, Ando H, Naito K, Suzuki A, Sakurai S, Nakano Y, Kurita A, Waseda K, Takashima H, Murotani K, Uetani T, Amano T (2018) Early-phase vascular healing of bioabsorbable vs. durable polymer-coated everolimus-eluting stents in patients with ST-elevation myocardial infarction- 2-week and 4-month analyses with optical coherence tomography. Circ J 82:2594–2601

    Article  CAS  Google Scholar 

  8. Soeda T, Uemura S, Park SJ, Jang Y, Lee S, Cho JM, Kim SJ, Vergallo R, Minami Y, Ong DS, Gao L, Lee H, Zhang S, Yu B, Saito Y, Jang IK (2015) Incidence and clinical significance of poststent optical coherence tomography findings: one-year follow-up study from a multicenter registry. Circulation 132:1020–1029

    Article  Google Scholar 

  9. Palmerini T, Biondi-Zoccai G, Della Riva D, Stettler C, Sangiorgi D, D'Ascenzo F, Kimura T, Briguori C, Sabate M, Kim HS, De Waha A, Kedhi E, Smits PC, Kaiser C, Sardella G, Marullo A, Kirtane AJ, Leon MB, Stone GW (2012) Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet 379:1393–1402

    Article  CAS  Google Scholar 

  10. Wiviott SD, Braunwald E, McCabe CH, Montalescot G, Ruzyllo W, Gottlieb S, Neumann FJ, Ardissino D, De Servi S, Murphy SA, Riesmeyer J, Weerakkody G, Gibson CM, Antman EM, Investigators T-T (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015

    Article  CAS  Google Scholar 

  11. Hong YJ, Jeong MH, Choi YH, Song JA, Kim DH, Lee KH, Yamanaka F, Lee MG, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC (2013) Impact of tissue prolapse after stent implantation on short- and long-term clinical outcomes in patients with acute myocardial infarction: an intravascular ultrasound analysis. Int J Cardiol 166:646–651

    Article  Google Scholar 

  12. Prati F, Romagnoli E, Gatto L, La Manna A, Burzotta F, Limbruno U, Versaci F, Fabbiocchi F, Di Giorgio A, Marco V, Ramazzotti V, Di Vito L, Trani C, Porto I, Boi A, Tavazzi L, Mintz GS (2016) Clinical impact of suboptimal stenting and residual intrastent plaque/thrombus protrusion in patients with acute coronary syndrome: The CLI-OPCI ACS substudy (Centro per la Lotta Contro L'Infarto-Optimization of Percutaneous Coronary Intervention in Acute Coronary Syndrome). Circ Cardiovasc Interv 9:e003726

    Article  CAS  Google Scholar 

  13. Brandt JT, Close SL, Iturria SJ, Payne CD, Farid NA, Ernest CS 2nd, Lachno DR, Salazar D, Winters KJ (2007) Common polymorphisms of CYP2C19 and CYP2C9 affect the pharmacokinetic and pharmacodynamic response to clopidogrel but not prasugrel. J Thromb Haemost 5:2429–2436

    Article  CAS  Google Scholar 

  14. Umemura K, Iwaki T (2016) The pharmacokinetics and pharmacodynamics of prasugrel and clopidogrel in healthy Japanese volunteers. Clin Pharmacol Drug Dev 5:480–487

    Article  CAS  Google Scholar 

  15. Farid NA, Kurihara A, Wrighton SA (2010) Metabolism and disposition of the thienopyridine antiplatelet drugs ticlopidine, clopidogrel, and prasugrel in humans. J Clin Pharmacol 50:126–142

    Article  CAS  Google Scholar 

  16. Rollini F, Franchi F, Hu J, Kureti M, Aggarwal N, Durairaj A, Park Y, Seawell M, Cox-Alomar P, Zenni MM, Guzman LA, Suryadevara S, Antoun P, Bass TA, Angiolillo DJ (2016) Crushed prasugrel tablets in patients with STEMI undergoing primary percutaneous coronary intervention: The CRUSH Study. J Am Coll Cardiol 67:1994–2004

    Article  CAS  Google Scholar 

  17. Jinnai T, Horiuchi H, Makiyama T, Tazaki J, Tada T, Akao M, Ono K, Hoshino K, Naruse Y, Takahashi K, Watanabe H, Kita T, Kimura T (2009) Impact of CYP2C19 polymorphisms on the antiplatelet effect of clopidogrel in an actual clinical setting in Japan. Circ J 73:1498–1503

    Article  CAS  Google Scholar 

  18. Ogawa H, Isshiki T, Kimura T, Yokoi H, Nanto S, Takayama M, Kitagawa K, Nishikawa M, Miyazaki S, Ikeda Y, Nakamura M, Tanaka Y, Saito S (2016) Effects of CYP2C19 allelic variants on inhibition of platelet aggregation and major adverse cardiovascular events in Japanese patients with acute coronary syndrome: the PRASFIT-ACS study. J Cardiol 68:29–36

    Article  Google Scholar 

  19. Kajander OA, Koistinen LS, Eskola M, Huhtala H, Bhindi R, Niemela K, Jolly SS, Sheth T, Total-Oct Substudy Investigators (2015) Feasibility and repeatability of optical coherence tomography measurements of pre-stent thrombus burden in patients with STEMI treated with primary PCI. Eur Heart J Cardiovasc Imaging 16:96–107

  20. Lee T, Yonetsu T, Koura K, Hishikari K, Murai T, Iwai T, Takagi T, Iesaka Y, Fujiwara H, Isobe M, Kakuta T (2011) Impact of coronary plaque morphology assessed by optical coherence tomography on cardiac troponin elevation in patients with elective stent implantation. Circ Cardiovasc Interv 4:378–386

    Article  CAS  Google Scholar 

  21. Sugiyama T, Kimura S, Akiyama D, Hishikari K, Kawaguchi N, Kamiishi T, Hikita H, Takahashi A, Isobe M (2014) Quantitative assessment of tissue prolapse on optical coherence tomography and its relation to underlying plaque morphologies and clinical outcome in patients with elective stent implantation. Int J Cardiol 176:182–190

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Heidi N. Bonneau, RN, MS, CCA, for her review of this manuscript.

Author information

Authors and Affiliations

  1. Department of Cardiology, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan

    Kazuhiro Naito, Yusuke Nakano, Katsuhisa Waseda, Hiroaki Takashima, Hirohiko Ando, Shinichiro Sakurai, Akihiro Suzuki, Yuki Saka, Hiroaki Sawada, Shigeko Nagahiro, Mayu Suzuki, Masahiro Shimoda & Tetsuya Amano

  2. Medical Education Center, Aichi Medical University, Nagakute, Japan

    Katsuhisa Waseda

Authors
  1. Kazuhiro Naito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuhisa Waseda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroaki Takashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hirohiko Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinichiro Sakurai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akihiro Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuki Saka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hiroaki Sawada
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shigeko Nagahiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mayu Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Masahiro Shimoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Tetsuya Amano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katsuhisa Waseda.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Supplementary file2 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naito, K., Nakano, Y., Waseda, K. et al. Impact of antiplatelet therapy on tissue prolapse at super acute phase after stenting: serial OCT study in acute coronary syndrome patients. Heart Vessels 36, 200–210 (2021). https://doi.org/10.1007/s00380-020-01686-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-020-01686-x

Keywords

Search

Navigation