Thromb Haemost 2016; 116(02): 369-378
DOI: 10.1160/TH15-12-0944
Atherosclerosis and Ischaemic Disease
Schattauer GmbH

P2Y12 receptor inhibition and effect of morphine in patients undergoing primary PCI for ST-segment elevation myocardial infarction

The PRIVATE-ATLANTIC study[*]
Johanne Silvain
1   Université Paris 06, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtriere University Hospital (AP-HP) - Paris, France
,
Robert F. Storey
2   Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
,
Guillaume Cayla
3   Service de Cardiology, CHU Caremeau, Nîmes, France
,
Jean-Baptiste Esteve
4   CHU de la Réunion, Réunion - Le Raincy-Montfermeil, Montfermeil, France
,
Jean-Guillaume Dillinger
5   Department of Cardiology, INSERM U942, Hôpital Lariboisière, AP-HP, Paris Diderot University, Paris, France
,
Hélène Rousseau
6   Unité de Recherche Clinique, Hôpital Lariboisière, Paris, France
,
Anne Tsatsaris
7   AstraZeneca, Rueil Malmaison, France
,
Caroline Baradat
7   AstraZeneca, Rueil Malmaison, France
,
Néjoua Salhi
8   AstraZeneca, Luton, United Kingdom
,
Christian W. Hamm
9   Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
,
Frédéric Lapostolle
10   SAMU 93, Hôpital Avicenne, Bobigny, France
,
Jens Flensted Lassen
11   Department of Cardiology B, Aarhus University Hospital, Skejby, Aarhus N, Denmark
,
Jean-Philippe Collet
1   Université Paris 06, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtriere University Hospital (AP-HP) - Paris, France
,
Jurrien M. ten Berg
12   Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
,
Arnoud W. van ’t Hof
13   Department of Cardiology, Isala Clinics, Zwolle, The Netherlands
,
Gilles Montalescot
1   Université Paris 06, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtriere University Hospital (AP-HP) - Paris, France
› Author Affiliations
Financial support: This study was supported by AstraZeneca and led by the ACTION Group (Allies in Cardiovascular Trials Initiatives and Organized Networks), www.action-coeur.org.
Further Information

Publication History

Received: 10 December 2015

Accepted after major revision: 19 April 2016

Publication Date:
09 March 2018 (online)

Summary

PRIVATE-ATLANTIC (P2Y12 Receptor Inhibition with VASP Testing using Elisa kit during the ATLANTIC study) is a pre-specified substudy of the randomised, double-blind ATLANTIC trial in patients with ST-segment elevation myocardial infarction, designed to help interpret the main trial results. The primary objective of ATLANTIC was to assess coronary reperfusion prior to percutaneous coronary intervention (PCI) with pre- vs in-hospital ticagrelor 180 mg loading dose (LD). PRIVATE-ATLANTIC assessed platelet inhibition in 37 patients by measurement of vasodilator-associated stimulated phosphoprotein (VASP) platelet reactivity index (PRI) and VerifyNow platelet reactivity units (PRU) before angiogram (T1), immediately after PCI (T2), 1 (T3), and 6 (T4) hours (h) after PCI, and before next study drug administration (T5). The median time difference between the two ticagrelor LD was 41 minutes. Platelet reactivity was unaffected at T1 when measured by VASP-PRI (89.8 vs 93.9% for pre- and in-hospital ticagrelor, respectively; p = 0.18) or PRU (239 vs 241; p = 0.82). Numerical differences were apparent at T2 and maximal at T3. Morphine administration significantly delayed onset of platelet inhibition at T3 (VASP-PRI 78.2 vs 23.4% without morphine; p = 0.0116) and T4 (33.1 vs 11.0%; p = 0.0057). In conclusion, platelet inhibition in ATLANTIC was unaffected by pre-hospital ticagrelor administration at the time of initial angiogram due to the short transfer delay. The maximum difference in platelet inhibition was detected 1 h after PCI (T3). Morphine administration was associated with delayed onset of action of ticagrelor and appeared more important than timing of ticagrelor administration.

* “PRIVATE-ATLANTIC” = P2Y12 Receptor Inhibition with VASP Testing using Elisa kit during the Administration of Ticagrelor in the Cath Lab or in the Ambulance for New ST elevation Myocardial Infarction to open the Coronary Artery