, on presentation with a STEMI, impacts around the impact of acute anti-thrombotic and anti-platelet therapy and exposes individuals to a risk of bleeding or ongoing thrombosis. We anticipate that demonstration with the baseline variation in platelet reactivity in individuals experiencing acute STEMI and definition of your pharmacodynamic response to combined treatment with bivalirudin and prasugrel will facilitate optimisation of pharmacotherapeutic approaches utilised inside the acute phase of therapy for STEMI.Trial statusRecruitment for the PINPOINT study is nearing completion, with 100patients recruited. It really is anticipated that the study results might be out there for dissemination later in 2013.Abbreviations STEMI: ST elevation myocardial infarction; PCI: Percutaneous coronary intervention; PPCI: Main percutaneous coronary intervention; BHI: Bristol Heart Institute; UFH: Unfractionated heparin; GPI: Glycoprotein 2b/3a inhibitor; MACE: Significant adverse cardiovascular events; ADP: Adenosine di-phosphate; MEA: Many electrode analyser; TIMI: Trials in myocardial infarction; ARC: Academic investigation consortium. Competing interests The authors declare that they have no competing interests. Authors’ contributions TJ conceived the study, AM, SM, MB, BR, AB TJ participated inside the design and style in the study, and writing on the protocol.2212021-56-0 site TJ, DM, AM, KP, RB, JWS, BR, CR AB contributed towards the writing of your manuscript and all authors have study and approved the final manuscript. Acknowledgements The study has been funded by the Above Beyond Charitable Trust, The Medicine’s Firm along with the UK National Institute for Overall health Analysis (NIHR) Bristol Cardiovascular Biomedical Analysis Unit. This paper presents independent analysis. The views expressed are these in the authors and not necessarily these of the NHS, the NIHR or the UK Division of Wellness. Author facts 1 Bristol Heart Institute, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK. 2University of Bristol, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK. Received: 29 June 2013 Accepted: 31 March 2014 Published: four April 2014 References 1.BuyFmoc-Dab(Alloc)-OH Keeley EC, Boura JA, Grines CL: Comparison of major and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative critique of randomised trials.PMID:23891445 Lancet 2006, 367(9510):579?88. 2. Mehran R, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Kornowski R, Hartmann F, Gersh BJ, Pocock SJ, Wong SC, Nikolsky E, Gambone L, Vandertie L, Parise H, Dangas GD, Stone GW: Bivalirudin in individuals undergoing major angioplasty for acute myocardial infarctionDiscussion This study is assessing the acute variability of platelet reactivity at the time of presentation with STEMI plus the influence of accelerated `door-to-balloon’ time on the platelet inhibitory impact of anti-thrombotic and antiplatelet agents within the first 24 hours of care. Debate continues with regards to the acute safety of bivalirudinJohnson et al. BMC Cardiovascular Issues 2014, 14:44 http://biomedcentral/1471-2261/14/Page 6 of3.4.five.six.7.eight.9.10.11.12.13. 14.15.(HORIZONS-AMI): 1-year benefits of a randomised controlled trial. Lancet 2009, 374(9696):1149?159. Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, Antman EM: Prasugrel compared with clopidogrel in individuals undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled tri.