Renal Function Assessed Using Cystatin C and Antiplatelet Efficacy of Clopidogrel Assessed Using the Vasodilator-Stimulated Phosphoprotein Index in Patients Having Percutaneous Coronary Intervention

Renal dysfunction is a strong independent predictor of stent thrombosis. The aim of the present study was to evaluate the strength and direction of the association between kidney function and clopidogrel efficacy. The study group consisted of consecutive patients (n = 275) who underwent stent implan...

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Published in:The American journal of cardiology 2012-03, Vol.109 (5), p.620-623
Main Authors: Motovska, Zuzana, MD, PhD, Odvodyova, Denisa, Bc, Fischerova, Michaela, MD, Stepankova, Sona, MD, Maly, Marek, PhD, Morawska, Petra, MD, Widimsky, Petr, MD, DrSc
Format: Article
Language:English
Subjects:
Aged
Angioplasty
Angioplasty, Balloon, Coronary - methods
Biological and medical sciences
Blood platelets
Blood Proteins
Cardiology
Cardiology. Vascular system
Cardiovascular
Cardiovascular disease
Cell Adhesion Molecules - blood
Coronary Artery Disease - physiopathology
Coronary Artery Disease - therapy
Coronary Thrombosis - blood
Coronary Thrombosis - physiopathology
Coronary Thrombosis - prevention & control
Cystatin C - blood
Diseases of the cardiovascular system
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Glomerular Filtration Rate - drug effects
Glomerular Filtration Rate - physiology
Humans
Immunoassay
Kidney Function Tests
Kidneys
Male
Medical sciences
Microfilament Proteins - blood
Phosphoproteins - blood
Platelet Aggregation Inhibitors - administration & dosage
Prognosis
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Stents
Thrombosis
Ticlopidine - administration & dosage
Ticlopidine - analogs & derivatives
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Summary:Renal dysfunction is a strong independent predictor of stent thrombosis. The aim of the present study was to evaluate the strength and direction of the association between kidney function and clopidogrel efficacy. The study group consisted of consecutive patients (n = 275) who underwent stent implantation. Drug efficacy was measured using the vasodilator-stimulated phosphoprotein (VASP) index 20 ± 4 hours after clopidogrel 600 mg. Nonresponse was defined as an VASP index ≥50%. Renal function was determined using serum cystatin C. The upper reference levels are 1.12 mg/L for ≤65 years of age and 1.21 mg/L for >65 years of age. Estimated glomerular filtration was calculated using cystatin C. The median value of cystatin C was 1.16 mg/L (twenty-fifth and seventy-fifth percentiles 0.96 and 1.43); 47.63% of the study population had cystatin C above reference levels and 33.1% of patients were nonresponders to clopidogrel. No correlation was found between clopidogrel efficacy assessed with the VASP index and kidney function assessed with cystatin C (Spearman r = −0.070, p = 0.248). Based on cystatin C the proportion of nonresponders to clopidogrel was 34.4% versus 31.9% (p = 0.702) in patients with impaired renal function compared to normal renal function, respectively. The proportion of clopidogrel nonresponders did not differ (p = 0.902) among groups with normal (28.8%), mildly impaired (34.8%), moderately impaired (32.9%), and severely impaired (34.8%) renal function. In conclusion, renal function assessed by cystatin C does not predict clopidogrel efficacy. Renal dysfunction is a complex entity and its significant relation to stent thrombosis cannot be explained simply by a decrease in clopidogrel efficacy.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2011.10.019