OBJECTIVES: This study sought to investigate clinical utility of on-site platelet function test and C-reactive protein (CRP) in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Data on long-term prognostic value of high on-treatment platelet reactivity (HTPR) on clopidogrel after PCI are limited. As a distinct biological pathway, CRP has been suggested to be associated with post-PCI atherothrombotic events. METHODS: We evaluated 2,849 patients who received drug-eluting stents (DES) and had post-PCI VerifyNow P2Y12 assays (Accumetrics, San Diego, California) performed. Among them, baseline CRP measurement was available in 2,546 patients. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, stent thrombosis, and stroke. RESULTS: During follow-up (median, 2.2 years), the occurrence of the primary endpoint did not significantly differ among patients with and without HTPR (2.8% vs. 2.4% at 2 years; hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 0.88 to 2.01; p = 0.18). By contrast, patients with elevated CRP levels were at significantly higher risk for the primary endpoint, as compared with those with nonelevated CRP levels (5.6% vs. 1.7% at 2 years; HR: 2.81, 95% CI:, 1.83 to 4.31; p < 0.001). The VerifyNow test had no incremental usefulness to classify long-term risk. However, the incorporation of CRP into a model with conventional clinical and procedural risk factors significantly improved the C-statistic for the prediction of the primary endpoint (0.729 to 0.759; p = 0.03). CONCLUSIONS: We failed to identify that HTPR measured by VerifyNow P2Y12 assay was significantly associated with long-term atherothrombotic risks in patients receiving DES. However, elevated CRP levels were significantly associated with worse outcomes and had incremental predictive values over conventional risk factors.
OBJECTIVES: This study sought to investigate clinical utility of on-site platelet function test and C-reactive protein (CRP) in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND: Data on long-term prognostic value of high on-treatment platelet reactivity (HTPR) on clopidogrel after PCI are limited. As a distinct biological pathway, CRP has been suggested to be associated with post-PCI atherothrombotic events. METHODS: We evaluated 2,849 patients who received drug-eluting stents (DES) and had post-PCI VerifyNow P2Y12 assays (Accumetrics, San Diego, California) performed. Among them, baseline CRP measurement was available in 2,546 patients. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, stent thrombosis, and stroke. RESULTS: During follow-up (median, 2.2 years), the occurrence of the primary endpoint did not significantly differ among patients with and without HTPR (2.8% vs. 2.4% at 2 years; hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 0.88 to 2.01; p = 0.18). By contrast, patients with elevated CRP levels were at significantly higher risk for the primary endpoint, as compared with those with nonelevated CRP levels (5.6% vs. 1.7% at 2 years; HR: 2.81, 95% CI:, 1.83 to 4.31; p < 0.001). The VerifyNow test had no incremental usefulness to classify long-term risk. However, the incorporation of CRP into a model with conventional clinical and procedural risk factors significantly improved the C-statistic for the prediction of the primary endpoint (0.729 to 0.759; p = 0.03). CONCLUSIONS: We failed to identify that HTPR measured by VerifyNow P2Y12 assay was significantly associated with long-term atherothrombotic risks in patients receiving DES. However, elevated CRP levels were significantly associated with worse outcomes and had incremental predictive values over conventional risk factors.
Authors: Saul M Genuth; Helen Vlachos; Maria Mori Brooks; John P Bantle; Bernard R Chaitman; Jennifer Green; Sheryl F Kelsey; Spencer B King; Robert McBane; Edward Y Sako; David J Schneider; Michael Steffes; Robert L Frye Journal: Mayo Clin Proc Date: 2019-10-04 Impact factor: 7.616
Authors: Rolf P Kreutz; Janelle Owens; Jeffrey A Breall; Deshun Lu; Elisabeth von der Lohe; Islam Bolad; Anjan Sinha; David A Flockhart Journal: Blood Coagul Fibrinolysis Date: 2013-04 Impact factor: 1.276
Authors: Rolf P Kreutz; Janelle Owens; Yan Jin; Perry Nystrom; Zeruesenay Desta; Yvonne Kreutz; Jeffrey A Breall; Lang Li; Chienwei Chiang; Richard J Kovacs; David A Flockhart Journal: Clin Pharmacol Date: 2013-12-09