High post-clopidogrel platelet reactivity assessed by a point-of-care assay predicts long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who underwent primary coronary stenting

Abstract Background Recent studies have shown that post-clopidogrel high platelet reactivity (HPR), assessed by a point-of-care assay, is associated with a higher risk of adverse events after percutaneous coronary intervention (PCI). We assessed the clinical impact of HPR by the VerifyNow P2Y12 poin...

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Published in:International journal of cardiology 2013-09, Vol.167 (5), p.1877-1881
Main Authors: Jin, Han-Young, Yang, Tae-Hyun, Kim, Doo-Il, Chung, Sang-Ryul, Seo, Jeong-Sook, Jang, Jae-Sik, Kim, Dae-Kyeong, Kim, Dong-Kie, Kim, Ki-Hun, Seol, Sang-Hoon, Nam, Chang-Wook, Hur, Seung-Ho, Kim, Woong, Park, Jong-Seon, Kim, Young-Jo, Kim, Dong-Soo
Format: Article
Language:English
Subjects:
Aged
Aspirin - administration & dosage
Biological and medical sciences
Blood Platelets - drug effects
Blood Platelets - metabolism
Cardiology. Vascular system
Cardiovascular
Cohort Studies
Coronary heart disease
Diseases of the cardiovascular system
Drug Therapy, Combination
Female
Heart
Humans
Male
Medical sciences
Middle Aged
Myocardial infarction
Myocardial Infarction - blood
Myocardial Infarction - diagnosis
Myocardial Infarction - therapy
Myocarditis. Cardiomyopathies
Percutaneous Coronary Intervention - methods
Percutaneous Coronary Intervention - trends
Platelet Aggregation Inhibitors - administration & dosage
Platelet reactivity
Point-of-care assay
Point-of-Care Systems - trends
Predictive Value of Tests
Prospective Studies
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Stents
Ticlopidine - administration & dosage
Ticlopidine - analogs & derivatives
Treatment Outcome
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Summary:Abstract Background Recent studies have shown that post-clopidogrel high platelet reactivity (HPR), assessed by a point-of-care assay, is associated with a higher risk of adverse events after percutaneous coronary intervention (PCI). We assessed the clinical impact of HPR by the VerifyNow P2Y12 point-of-care assay in 181 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary PCI with drug-eluting stents (DES) at 3 hospitals. Methods The primary endpoint of the study was the 12-month major adverse cardiovascular events (MACE), which comprised cardiovascular death, nonfatal MI and ischemic stroke. All patients received a single loading dose of 600 mg clopidogrel and 300 mg aspirin followed by a daily maintenance dose of 75 mg clopidogrel and 100 mg aspirin. Results A P2Y12 reaction unit (PRU) ≥ 282 (AUC 0.719, 95% CI 0.588–0.851, p = 0.004, sensitivity 68.8%, specificity 73.8%) was the optimal cut-off value in predicting 12-month MACE by receiver operating characteristic curve analysis. Occurrence of MACE was significantly more frequent in patients with HPR (PRU ≥ 282) compared to patients without HPR (20.4% vs. 3.9%, HR 6.24, 95% CI 2.05–18.99, p = 0.001). By multivariate analysis, HPR (HR 3.84, 95% CI 1.17–12.58, p = 0.026) and elderly patients above 80 years of age (HR: 8.13, 95% CI 1.79–37.03, p = 0.007) were found to be the significant predictors of 12-month MACE. The MACE-free survival rate was significantly lower in patients with HPR compared to patients without HPR (p < 0.001). Conclusion HPR assessed by a point-of-care assay was able to predict 12-month MACE in patients with STEMI who underwent primary PCI with DES.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2012.04.154