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Title: Platelet inhibition to target reperfusion injury trial: Rationale and study design
Authors: Bulluck, Heerajnarain
Chan, Mervyn HH
Bryant, Jennifer A
Chai, Ping 
Chawla, Ashish
Chua, Terrance S
Chung, Yiu-Cho
Fei, Gao 
Ho, Hee H
Ho, Andrew FW
Hoe, Andrew J
Imran, Syed S
Lee, Chi-Hang 
Lim, Swee H
Liew, Boon W 
Yun, Patrick LZ
Hock, Marcus OE 
Paradies, Valeria
Roe, Matthew T
Teo, Lynette
Wong, Aaron S
Wong, Evelyn 
Wong, Philip E
Watson, Timothy
Chan, Mark Y 
Tan, Jack W
Hausenloy, Derek J
Keywords: cangrelor
cardiovascular magnetic resonance imaging
microvascular obstruction
myocardial infarct size
primary percutaneous coronary intervention
reperfusion injury
ST-segment elevation myocardial infarction
Issue Date: 1-Jan-2019
Publisher: WILEY
Citation: Bulluck, Heerajnarain, Chan, Mervyn HH, Bryant, Jennifer A, Chai, Ping, Chawla, Ashish, Chua, Terrance S, Chung, Yiu-Cho, Fei, Gao, Ho, Hee H, Ho, Andrew FW, Hoe, Andrew J, Imran, Syed S, Lee, Chi-Hang, Lim, Swee H, Liew, Boon W, Yun, Patrick LZ, Hock, Marcus OE, Paradies, Valeria, Roe, Matthew T, Teo, Lynette, Wong, Aaron S, Wong, Evelyn, Wong, Philip E, Watson, Timothy, Chan, Mark Y, Tan, Jack W, Hausenloy, Derek J (2019-01-01). Platelet inhibition to target reperfusion injury trial: Rationale and study design. CLINICAL CARDIOLOGY 42 (1) : 5-12. ScholarBank@NUS Repository.
Abstract: Background: In ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI), current oral P2Y12 platelet inhibitors do not provide maximal platelet inhibition at the time of reperfusion. Furthermore, administration of cangrelor prior to reperfusion has been shown in pre-clinical studies to reduce myocardial infarct (MI) size. Therefore, we hypothesize that cangrelor administered prior to reperfusion in STEMI patients will reduce the incidence of microvascular obstruction (MVO) and limit MI size in STEMI patients treated with PPCI. Methods: The platelet inhibition to target reperfusion injury (PITRI) trial, is a phase 2A, multi-center, double-blinded, randomized controlled trial, in which 210 STEMI patients will be randomized to receive either an intravenous (IV) bolus of cangrelor (30 μg/kg) followed by a 120-minute infusion (4 μg/kg/min) or matching saline placebo, initiated prior to reperfusion (NCT03102723). Results: The study started in October 2017 and the anticipated end date would be July 2020. The primary end-point will be MI size quantified by cardiovascular magnetic resonance (CMR) on day 3 post-PPCI. Secondary endpoints will include markers of reperfusion, incidence of MVO, MI size, and adverse left ventricular remodeling at 6 months, and major adverse cardiac and cerebrovascular events. Summary: The aim of the PITRI trial is to assess whether cangrelor administered prior to reperfusion would reduce acute MI size and MVO, as assessed by CMR.
ISSN: 01609289
DOI: 10.1002/clc.23110
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