Do dual anti-platelet treatments (DAPTs) protect the coronary microcirculation of the injured and diabetic heart?

Muscle damage and heart failure still occurs in a significant proportion of heart attack patients following a primary percutaneous coronary intervention (PCI). Furthermore, poorer outcomes are observed in patients with type 2 diabetes. We believe this is due to inadequate coronary perfusion at a microvascular level.

Indeed, we have intravitally imaged in the mouse beating heart multiple microvascular perturbations, with platelet-rich microthrombi the main contributors to reduced functional capillary density in the immediate aftermath of reperfusion.

Whether clinically relevant dual anti-platelet therapies have any beneficial effects at the level of the coronary microcirculation is not clear.

This project aims to intravitally assess which combination of aspirin ± platelet P2Y12 inhibitors effectively maintain the patency of the injured coronary microcirculation in the presence or absence of hyperglycaemia. Alternative approaches will also tested, such as platelet GPIba receptor inhibition and heparin infusion.

Data generated will be able to guide the contemporary anti-thrombotic management of heart attack patients in the period immediately post-PCI .