PMID- 35171384
OWN - NLM
STAT- MEDLINE
DCOM- 20221115
LR  - 20221118
IS  - 1573-7241 (Electronic)
IS  - 0920-3206 (Linking)
VI  - 36
IP  - 6
DP  - 2022 Dec
TI  - Do We Really Need Aspirin Loading for STEMI?
PG  - 1221-1238
LID - 10.1007/s10557-022-07327-x [doi]
AB  - Aspirin loading (chewable or intravenous) as soon as possible after presentation 
      is a class I recommendation by current ST elevation myocardial infarction (STEMI) 
      guidelines. Earlier achievement of therapeutic antiplatelet effects by aspirin 
      loading has long been considered the standard of care. However, the effects of 
      the loading dose of aspirin (alone or in addition to a chronic maintenance oral 
      dose) have not been studied. A large proportion of myocardial cell death occurs 
      upon and after reperfusion (reperfusion injury). Numerous agents and 
      interventions have been shown to limit infarct size in animal models when 
      administered before or immediately after reperfusion. However, these 
      interventions have predominantly failed to show significant protection in 
      clinical studies. In the current review, we raise the hypothesis that aspirin 
      loading may be the culprit. Data obtained from animal models consistently show 
      that statins, ticagrelor, opiates, and ischemic postconditioning limit myocardial 
      infarct size. In most of these studies, aspirin was not administered. However, 
      when aspirin was administered before reperfusion (as is the case in the majority 
      of studies enrolling STEMI patients), the protective effects of statin, 
      ticagrelor, morphine, and ischemic postconditioning were attenuated, which can be 
      plausibly attributable to aspirin loading. We therefore suggest studying the 
      effects of aspirin loading before reperfusion on the infarct size limiting 
      effects of statins, ticagrelor, morphine, and/ or postconditioning in large 
      animal models using long reperfusion periods (at least 24 h). If indeed aspirin 
      attenuates the protective effects, clinical trials should be conducted comparing 
      aspirin loading to alternative antiplatelet regimens without aspirin loading in 
      patients with STEMI undergoing primary percutaneous coronary intervention.
CI  - (c) 2022. The Author(s), under exclusive licence to Springer Science+Business 
      Media, LLC, part of Springer Nature.
FAU - Ye, Regina
AU  - Ye R
AD  - University of Texas at Austin, Austin, TX, USA.
FAU - Jneid, Hani
AU  - Jneid H
AD  - Department of Medicine Baylor College of Medicine, 7200 Cambridge Street Houston, 
      Texas, 77030, USA.
FAU - Alam, Mahboob
AU  - Alam M
AD  - Department of Medicine Baylor College of Medicine, 7200 Cambridge Street Houston, 
      Texas, 77030, USA.
FAU - Uretsky, Barry F
AU  - Uretsky BF
AD  - University of Arkansas for Medical Sciences, Central Arkansas Veterans Health 
      System, Little Rock, AR, USA.
FAU - Atar, Dan
AU  - Atar D
AD  - Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway, and 
      Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
FAU - Kitakaze, Masafumi
AU  - Kitakaze M
AD  - Center of Medical Innovation and Translational Research, Department of Medical 
      Data Science, Osaka University Graduate School of Medicine, Osaka, Japan.
FAU - Davidson, Sean M
AU  - Davidson SM
AD  - The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, 
      London, WC1E 6HX, UK.
FAU - Yellon, Derek M
AU  - Yellon DM
AD  - The Hatter Cardiovascular Institute, University College London, 67 Chenies Mews, 
      London, WC1E 6HX, UK.
FAU - Birnbaum, Yochai
AU  - Birnbaum Y
AUID- ORCID: 0000-0001-7653-6328
AD  - Department of Medicine Baylor College of Medicine, 7200 Cambridge Street Houston, 
      Texas, 77030, USA. ybirnbau@bcm.edu.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20220216
PL  - United States
TA  - Cardiovasc Drugs Ther
JT  - Cardiovascular drugs and therapy
JID - 8712220
RN  - R16CO5Y76E (Aspirin)
RN  - GLH0314RVC (Ticagrelor)
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Morphine Derivatives)
SB  - IM
MH  - Animals
MH  - *ST Elevation Myocardial Infarction/therapy
MH  - Aspirin
MH  - Ticagrelor
MH  - *Hydroxymethylglutaryl-CoA Reductase Inhibitors
MH  - *Percutaneous Coronary Intervention/adverse effects
MH  - Morphine Derivatives
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Animal models
OT  - Aspirin
OT  - Humans
OT  - Infarct size
OT  - Postconditioning
OT  - Reperfusion injury
OT  - STEMI
OT  - Statins
EDAT- 2022/02/17 06:00
MHDA- 2022/11/16 06:00
CRDT- 2022/02/16 12:16
PHST- 2022/02/11 00:00 [accepted]
PHST- 2022/02/17 06:00 [pubmed]
PHST- 2022/11/16 06:00 [medline]
PHST- 2022/02/16 12:16 [entrez]
AID - 10.1007/s10557-022-07327-x [pii]
AID - 10.1007/s10557-022-07327-x [doi]
PST - ppublish
SO  - Cardiovasc Drugs Ther. 2022 Dec;36(6):1221-1238. doi: 10.1007/s10557-022-07327-x. 
      Epub 2022 Feb 16.