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Dual Antiplatelet Therapy with 3rd Generation P2Y12 Inhibitors in STEMI Patients: Impact of Body Mass Index on Loading Dose–Response

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An Editorial to this article was published on 18 August 2023

An Invited Editorial to this article was published on 02 August 2023

Abstract

Purpose

This study aims to assess the association between body mass index (BMI) and platelet reactivity in STEMI patients treated with oral 3rd generation P2Y12 inhibitors.

Methods

Overall, 429 STEMI patients were enrolled in this study. Patients were divided into two groups according to BMI (BMI < 25 vs ≥ 25 kg/m2). A propensity score matching (1:1) was performed to balance potential confounders in patient baseline characteristics. Platelet reactivity was assessed by VerifyNow at baseline and after 3rd generation P2Y12 inhibitor (ticagrelor or prasugrel) loading dose (LD). Blood samples were obtained at baseline (T0), 1 h (T1), 2 h (T2), 4–6 h (T3), and 8–12 h (T4) after the LD. High on-treatment platelet reactivity (HTPR) was defined as a platelet reactivity unit value ≥ 208 units.

Results

After propensity score matching, patients with BMI ≥ 25 had similar values of baseline platelet reactivity, while they had higher level of platelet reactivity at 1 and 2 h after the LD and higher rate of HRPT. Furthermore, multivariate analysis demonstrated that BMI ≥ 25 was an independent predictor of HTPR at 2 h (OR 2.01, p = .009). Conversely, starting from 4 h after the LD, platelet reactivity values and HRPT rates were comparable among the two study groups.

Conclusions

A BMI ≥ 25 kg/m2 is associated with delayed pharmacodynamic response to oral 3rd generation P2Y12 inhibitor LD, and it is a strong predictor of HTPR in STEMI patients treated by dual antiplatelet therapy with ticagrelor or prasugrel.

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Data Availability

The data that support the findings of this study are available from the corresponding author, GP, upon reasonable request.

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Acknowledgements

The authors are indebted to the Cath Lab staff and the CCU fellows and nurses for their precious help in collecting and processing blood samples.

Author information

Authors and Affiliations

  1. Medical Sciences Departement, Cardiology Unit, ASST Bergamo Est, Bolognini Hospital, Seriate, BG, Italy

    Fernando Scudiero

  2. Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy

    Mario E. Canonico & Giovanni Esposito

  3. Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy

    Giuseppe D. Sanna & Filippo Dossi

  4. Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (Salerno), Italy

    Angelo Silverio & Gennaro Galasso

  5. Department of Internal Medicine and Medical Specialties (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy

    Italo Porto

  6. Cardiology Unit, ASL4 Liguria, Ospedali del Tigullio, Polo Di Lavagna, GE, Italy

    Filippo Dossi & Guido Parodi

Authors
  1. Fernando Scudiero
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  2. Mario E. Canonico
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  3. Giuseppe D. Sanna
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  8. Italo Porto
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  9. Guido Parodi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Fernando Scudiero, Mario Enrico Canonico, and Guido Parodi. The first draft of the manuscript was written by Fernando Scudiero and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Guido Parodi.

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Competing Interests

Prof. Guido Parodi reported receiving consulting or lecture fees from AstraZeneca, Bayer, Chiesi, Daiichi Sankyo/Eli Lilly, and Merck Sharp Dohme. All other authors declare no competing interests.

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Supplementary Information

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Supplementary file1 (DOCX 9.46 KB)

Supplementary file2 (DOCX 8.33 KB)

Supplementary Figure 1.

histogram of BMI distribution in the enrolled patients (PNG 574 KB)

High Resolution (TIFF 8101 KB)

Supplementary Figure 2.

Scattered plots depicting PRU values according to BMI (PNG 1.17 MB)

High Resolution (TIFF 154 KB)

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Scudiero, F., Canonico, M.E., Sanna, G.D. et al. Dual Antiplatelet Therapy with 3rd Generation P2Y12 Inhibitors in STEMI Patients: Impact of Body Mass Index on Loading Dose–Response. Cardiovasc Drugs Ther 37, 695–703 (2023). https://doi.org/10.1007/s10557-022-07322-2

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