Tullio Palmerini1, Paolo Calabrò2, Federico Piscione3, Stefano De Servi4, Marco Cattaneo5, Diego Maffeo6, Anna Toso7, Antonio Bartorelli8, Cataldo Palmieri9, Marco De Carlo10, Davide Capodanno11, Chiara Barozzi12, Luciana Tomasi12, Diego Della Riva12, Andrea Mariani12, Nevio Taglieri12, Letizia Bacchi Reggiani12, Renatomaria Bianchi2, Roberta De Rosa13, Matteo Mariani4, GianMarco Podda5, Philippe Généreux14, Gregg W Stone14, Dominick J Angiolillo15. 1. Cardiovascular Department, Policlinico S. Orsola, Bologna, Italy. Electronic address: tulliopalmerini@hotmail.com. 2. Department of Cardiothoracic Science, Second University of Naples, A.O. dei Colli, Monaldi, Naples, Italy. 3. Department of Medicine and Surgery, University of Salerno, Salerno, Italy. 4. Legnano Hospital, Legnano, Italy. 5. Department of Health Science, University of Milan, Milan, Italy. 6. Cardiothoracic Department, Spedali Civili, Brescia, Italy. 7. Cardiology Division, Prato Hospital, Prato, Italy. 8. Monzino Heart Center, IRCCS, Milan, Italy. 9. Department of Interventional Cardiology, Heart Hospital, Massa, Italy. 10. Catheterization Laboratory, Azienda Ospedaliero-Universitaria Pisa, Pisa, Italy. 11. Ferrarotto Hospital, University of Catania, Catania, Italy. 12. Cardiovascular Department, Policlinico S. Orsola, Bologna, Italy. 13. Department of Advanced Biomedical Sciences, Università Federico II, Naples, Italy. 14. Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York. 15. Department of Medicine/Division of Cardiology, University of Florida, Jacksonville, Florida.
Abstract
OBJECTIVES: The aim of this study was to investigate the association between high on-treatment platelet reactivity (HPR) and the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) for risk prediction of major adverse cardiovascular events (MACE) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI). BACKGROUND: Platelet function testing may be used to optimize antiplatelet therapy in high-risk patients, but identification of this category of patients remains challenging. METHODS: The GEPRESS (Gene Polymorphism, Platelet Reactivity, and the Syntax Score) study was a prospective, multicenter, observational study enrolling 1,053 patients with NSTEACS undergoing PCI and treated with clopidogrel. The platelet reactivity index (PRI) was measured at 3 time points: before PCI, at hospital discharge, and 1 month after PCI. Genetic variants of clopidogrel metabolism were determined in 750 patients. Patients were stratified by the presence of HPR (PRI >50%) and by tertile of the SS (upper SS tertile ≥15). The primary objective of this study was the risk of MACE in the period between 1 month and 1 year. RESULTS: Between 1 month and 1 year, 1-month HPR was an independent predictor of MACE in patients with an SS ≥15, but not in those with an SS <15, displaying a 5-fold increase in event rates (10.4% vs. 2.5%; p < 0.0001). CYP2C19*2 was the only single nucleotide polymorphism associated with HPR, but it was not associated with MACE. Although there was a significant variability in the PRI across the 1-month period, predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up. CONCLUSIONS: In clopidogrel-treated patients with NSTEACS undergoing PCI, HPR was independently associated with an increased risk of MACE only in the presence of a high SS.
OBJECTIVES: The aim of this study was to investigate the association between high on-treatment platelet reactivity (HPR) and the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) for risk prediction of major adverse cardiovascular events (MACE) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI). BACKGROUND: Platelet function testing may be used to optimize antiplatelet therapy in high-risk patients, but identification of this category of patients remains challenging. METHODS: The GEPRESS (Gene Polymorphism, Platelet Reactivity, and the Syntax Score) study was a prospective, multicenter, observational study enrolling 1,053 patients with NSTEACS undergoing PCI and treated with clopidogrel. The platelet reactivity index (PRI) was measured at 3 time points: before PCI, at hospital discharge, and 1 month after PCI. Genetic variants of clopidogrel metabolism were determined in 750 patients. Patients were stratified by the presence of HPR (PRI >50%) and by tertile of the SS (upper SS tertile ≥15). The primary objective of this study was the risk of MACE in the period between 1 month and 1 year. RESULTS: Between 1 month and 1 year, 1-month HPR was an independent predictor of MACE in patients with an SS ≥15, but not in those with an SS <15, displaying a 5-fold increase in event rates (10.4% vs. 2.5%; p < 0.0001). CYP2C19*2 was the only single nucleotide polymorphism associated with HPR, but it was not associated with MACE. Although there was a significant variability in the PRI across the 1-month period, predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up. CONCLUSIONS: In clopidogrel-treated patients with NSTEACS undergoing PCI, HPR was independently associated with an increased risk of MACE only in the presence of a high SS.
Authors: Teresa Strisciuglio; Giuseppe Di Gioia; Chiara De Biase; Massimiliano Esposito; Danilo Franco; Bruno Trimarco; Emanuele Barbato Journal: High Blood Press Cardiovasc Prev Date: 2015-05-19
Authors: Anna Toso; Stefano De Servi; Mario Leoncini; Dominick J Angiolillo; Paolo Calabrò; Federico Piscione; Marco Cattaneo; Diego Maffeo; Antonio Bartorelli; Cataldo Palmieri; Marco De Carlo; Davide Capodanno; Philippe Genereux; Francesco Bellandi; Chiara Barozzi; Luciana Tomasi; Diego Della Riva; Tullio Palmerini Journal: J Thromb Thrombolysis Date: 2017-10 Impact factor: 2.300
Authors: Lukasz Milanowski; Justyna Pordzik; Piotr K Janicki; Agnieszka Kaplon-Cieslicka; Marek Rosiak; Michal Peller; Agata Tyminska; Krzysztof Ozieranski; Krzysztof J Filipiak; Grzegorz Opolski; Dagmara Mirowska-Guzel; Marek Postula Journal: Acta Diabetol Date: 2016-12-19 Impact factor: 4.280