{
  "abstract": "Aims: Microvascular obstruction (MVO) remains a major complication following coronary reperfusion, but its pathogenesis is poorly defined. We evaluated myocardial platelet activation and thrombosis using fluorine-18-labelled GP1 ([18F]GP1) positron emission tomography (PET) in patients with anterior ST-segment elevation myocardial infarction.\n\nMethods and results: In a single-centre observational cohort study, 100 patients with acute anterior ST-segment elevation myocardial infarction underwent hybrid cardiac [18F]GP1 PET and magnetic resonance (MR) imaging with gadolinium enhancement and repeat imaging at 3–6 months. Myocardial [18F]GP1 uptake was quantified using target-to-background ratio (TBRmax) and percentage myocardial uptake (burden) and compared with MR measures of infarction, MVO and adverse ventricular remodelling. One hundred patients (60 ± 10 years, 91% male) underwent [18F]GP1 PET/MR imaging at a median of 13 days following index presentation. Increased myocardial [18F]GP1 uptake was observed in 44% of participants (TBRmax 1.89 ± 0.50). All 40 patients with MR-defined MVO demonstrated myocardial [18F]GP1 uptake. Myocardial [18F]GP1 uptake burden correlated with (ρ = 0.84; P < 0.001), and exceeded (by 18%), MR-defined burden of MVO. Myocardial [18F]GP1 uptake was associated with infarct size, lower left ventricular ejection fraction and longer time-to-reperfusion. Angiographic no-reflow was the strongest independent association of MVO (adjusted odds ratio 16.15; P < 0.001). Persistent myocardial [18F]GP1 uptake at follow up (22%, 7/32) was associated with lower left ventricular ejection fraction. Resolution of cardiac MR-defined MVO was observed in 78% of patients at follow-up and was universally concordant with resolution of myocardial [18F]GP1 uptake.\n\nConclusion: MVO following ST-segment elevation myocardial infarction is universally associated with myocardial platelet activation, extending beyond structural abnormalities identified by cardiac MR. These findings are consistent with an important mechanistic contribution of platelet-mediated microvascular thrombosis to no-reflow and MVO, highlighting a potentially targetable biological pathway in a condition for which effective therapies remain elusive.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 20,
  "authors": [
    {
      "name": "Craig Balmforth",
      "orcid": "0009-0005-1991-0017"
    },
    {
      "name": "Alessandro Giaj Levra",
      "orcid": "0000-0001-7779-5276"
    },
    {
      "name": "Beth Whittington",
      "orcid": "0000-0003-2833-5980"
    },
    {
      "name": "Aidan Morgan",
      "orcid": "0009-0008-0465-7065"
    },
    {
      "name": "Mark G Macaskill",
      "orcid": "0000-0001-5355-3109"
    },
    {
      "name": "Evangelos Tzolos",
      "orcid": "0000-0003-0038-043X"
    },
    {
      "name": "Alex J Jordan",
      "orcid": "0009-0004-0687-6641"
    },
    {
      "name": "Tariq Ramtoola",
      "orcid": "0000-0002-4036-9043"
    },
    {
      "name": "Tim Clark"
    },
    {
      "name": "Michelle Rooney",
      "orcid": "0009-0007-1651-171X"
    },
    {
      "name": "Christophe Lucatelli",
      "orcid": "0000-0001-9866-7257"
    },
    {
      "name": "Edwin J R van Beek",
      "orcid": "0000-0002-2777-5071"
    },
    {
      "name": "Piotr J Slomka",
      "orcid": "0000-0002-6110-938X"
    },
    {
      "name": "Stephanie L Sellers"
    },
    {
      "name": "Norman Koglin",
      "orcid": "0000-0001-7583-8201"
    },
    {
      "name": "Andrew W Stephens",
      "orcid": "0000-0001-5052-6586"
    },
    {
      "name": "Iris Hardewig",
      "orcid": "0000-0001-9865-9302"
    },
    {
      "name": "David E Newby",
      "orcid": "0000-0001-7971-4628"
    },
    {
      "name": "Michelle C Williams",
      "orcid": "0000-0003-3556-2428"
    },
    {
      "name": "Marc R Dweck",
      "orcid": "0000-0001-9847-5917"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b532esv7awagn.bib",
  "cited_by": 0,
  "doi": "10.1093/ehjci/jeag225",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13721768/",
  "id": "b532esv7awagn",
  "issns": [
    "2047-2404",
    "2047-2412"
  ],
  "landing_url": "https://doi.org/10.1093/ehjci/jeag225",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00200"
    ],
    [
      "heading",
      "Editor's Choice"
    ],
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      "heading",
      "Eurheartj/15"
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    [
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    [
      "heading",
      "Original Paper"
    ],
    [
      "openalex",
      "2741|Cardiac Imaging and Diagnostics"
    ]
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  "openalex": "W7204718562",
  "pdf_url": null,
  "pmcid": "PMC13721768",
  "pmid": "42668434",
  "published": "2026-08-30",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/b532esv7awagn.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T12:22:24Z",
      "native_id": "PMC13721768",
      "source": "pmc",
      "url": "https://doi.org/10.1093/ehjci/jeag225"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2741|Cardiac Imaging and Diagnostics",
      "subfield": "imaging"
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  "title": "Platelet activation and thrombosis in microvascular obstruction",
  "title_text": "Platelet activation and thrombosis in microvascular obstruction",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:22:24Z",
  "url": "https://research.draconitic.com/paper/b532esv7awagn",
  "venue": "European Heart Journal Cardiovascular Imaging",
  "versions": []
}