BACKGROUND: Recent studies suggest a high interindividual variability of response to clopidogrel associated with adverse cardiovascular outcome. Different clinical factors are considered to influence a persistent residual platelet aggregation (RPA) despite conventional antiplatelet therapy. OBJECTIVES: To investigate clinical factors that affect RPA after 600-mg clopidogrel loading in a large unselected cohort of patients with symptomatic CAD. METHODS: The study population included a consecutive cohort of 1,092 patients treated with coronary stenting for stable angina and acute coronary syndromes (ACS). Residual platelet activity was assessed by ADP (20 micromol L(-1))-induced platelet aggregation >or= 6 h after LD. Eleven clinical factors were included in the primary analysis. RESULTS: In multivariate regression analysis increased RPA was significantly influenced by ACS, reduced LV-function, diabetes mellitus, renal failure (creatinine > 1.5 mg dL(-1)), and age > 65 years. In a factor-weighed model the risk for high RPA increased with higher score levels (OR for patients with a score of 1-3, 1.21, 95% CI 0.7-2.1; score 4-6, OR 2.0, 95% CI 1.17-3.5; P = 0.01; score 7-9, OR 3.3, 95% CI 1.8-6.0). During a 30-day follow-up the incidence of major adverse events was higher in patients with RPA in the upper tertile (4.8% vs. 2.5% in the 2nd and 1.5% in the 1st tertile; P < 0.05). CONCLUSIONS: The PREDICT score provides a good tool to estimate residual platelet activity after clopidogrel LD by easily available patient details. Additionally, we demonstrate its association with short-term outcome. Thus, patients with a high score may benefit from intensified antiplatelet therapy by improved platelet inhibition and risk reduction for thromboischemic events.
BACKGROUND: Recent studies suggest a high interindividual variability of response to clopidogrel associated with adverse cardiovascular outcome. Different clinical factors are considered to influence a persistent residual platelet aggregation (RPA) despite conventional antiplatelet therapy. OBJECTIVES: To investigate clinical factors that affect RPA after 600-mg clopidogrel loading in a large unselected cohort of patients with symptomatic CAD. METHODS: The study population included a consecutive cohort of 1,092 patients treated with coronary stenting for stable angina and acute coronary syndromes (ACS). Residual platelet activity was assessed by ADP (20 micromol L(-1))-induced platelet aggregation >or= 6 h after LD. Eleven clinical factors were included in the primary analysis. RESULTS: In multivariate regression analysis increased RPA was significantly influenced by ACS, reduced LV-function, diabetes mellitus, renal failure (creatinine > 1.5 mg dL(-1)), and age > 65 years. In a factor-weighed model the risk for high RPA increased with higher score levels (OR for patients with a score of 1-3, 1.21, 95% CI 0.7-2.1; score 4-6, OR 2.0, 95% CI 1.17-3.5; P = 0.01; score 7-9, OR 3.3, 95% CI 1.8-6.0). During a 30-day follow-up the incidence of major adverse events was higher in patients with RPA in the upper tertile (4.8% vs. 2.5% in the 2nd and 1.5% in the 1st tertile; P < 0.05). CONCLUSIONS: The PREDICT score provides a good tool to estimate residual platelet activity after clopidogrel LD by easily available patient details. Additionally, we demonstrate its association with short-term outcome. Thus, patients with a high score may benefit from intensified antiplatelet therapy by improved platelet inhibition and risk reduction for thromboischemic events.
Authors: Patrik Htun; Suzanne Fateh-Moghadam; Christian Bischofs; Winston Banya; Karin Müller; Boris Bigalke; Konstantinos Stellos; Andreas E May; Marcus Flather; Meinrad Gawaz; Tobias Geisler Journal: J Am Soc Nephrol Date: 2011-01-27 Impact factor: 10.121
Authors: Thomas O Bergmeijer; Jean-Luc Reny; Ruth E Pakyz; Li Gong; Joshua P Lewis; Eun-Young Kim; Daniel Aradi; Israel Fernandez-Cadenas; Richard B Horenstein; Ming Ta Michael Lee; Ryan M Whaley; Joan Montaner; Gian Franco Gensini; John H Cleator; Kiyuk Chang; Lene Holmvang; Willibald Hochholzer; Dan M Roden; Stefan Winter; Russ B Altman; Dimitrios Alexopoulos; Ho-Sook Kim; Jean-Pierre Déry; Meinrad Gawaz; Kevin Bliden; Marco Valgimigli; Rossella Marcucci; Gianluca Campo; Elke Schaeffeler; Nadia P Dridi; Ming-Shien Wen; Jae Gook Shin; Tabassome Simon; Pierre Fontana; Betti Giusti; Tobias Geisler; Michiaki Kubo; Dietmar Trenk; Jolanta M Siller-Matula; Jurriën M Ten Berg; Paul A Gurbel; Jean-Sebastien Hulot; Braxton D Mitchell; Matthias Schwab; Marylyn DeRiggi Ritchie; Teri E Klein; Alan R Shuldiner Journal: Am Heart J Date: 2017-12-17 Impact factor: 4.749
Authors: Henrik Wagner; Dominick J Angiolillo; Jurrien M Ten Berg; Thomas O Bergmeijer; Joseph A Jakubowski; David S Small; Brian A Moser; Chunmei Zhou; Patricia Brown; Stefan James; Kenneth J Winters; David Erlinge Journal: J Thromb Thrombolysis Date: 2014 Impact factor: 2.300