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 100mg 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.
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 100mg 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.
Authors: María Henar García-Lagunar; Luciano Consuegra-Sánchez; Pablo Conesa-Zamora; Javier Ruiz-Cosano; Federico Soria-Arcos; Luis García de Guadiana; Pedro Cano Vivar; Juan Antonio Castillo-Moreno; Antonio Melgarejo-Moreno Journal: Anatol J Cardiol Date: 2017-02-01 Impact factor: 1.596
Authors: Nina W van der Hoeven; Gladys N Janssens; Henk Everaars; Alexander Nap; Jorrit S Lemkes; Guus A de Waard; Peter M van de Ven; Albert C van Rossum; Javier Escaned; Hernan Mejia-Renteria; Tim J F Ten Cate; Jan J Piek; Clemens von Birgelen; Marco Valgimigli; Roberto Diletti; Niels P Riksen; Nicolas M Van Mieghem; Robin Nijveldt; Maarten A H van Leeuwen; Niels van Royen Journal: J Am Heart Assoc Date: 2020-03-03 Impact factor: 5.501
Authors: Jae Min Kim; Jin Sug Kim; Hyung Oh Kim; So Ra Lee; Jae Hwan Rhew; Jong Shin Woo; Jang Hyun Cho; Kyung Hwan Jeong; Weon Kim Journal: Medicine (Baltimore) Date: 2020-03 Impact factor: 1.817