Igor Mrdovic1,2, Mirko Čolić3, Lidija Savic4, Gordana Krljanac5,4, Peter Kruzliak6, Ratko Lasica5,4, Milika Asanin5,4, Sanja Stanković7, Jelena Marinkovic5,8. 1. University of Belgrade School of Medicine, Belgrade, Serbia. igormrd@gmail.com. 2. Clinical Center of Serbia, Emergency Hospital & Cardiology Clinic, Coronary Care Unit A, Pasterova 2, Belgrade, 11 000, Serbia. igormrd@gmail.com. 3. Institute of Cardiovascular Diseases Dedinje, Belgrade, Serbia. 4. Clinical Center of Serbia, Emergency Hospital & Cardiology Clinic, Coronary Care Unit A, Pasterova 2, Belgrade, 11 000, Serbia. 5. University of Belgrade School of Medicine, Belgrade, Serbia. 6. 2nd Department of Internal Medicine, Faculty of Medicine, Masaryk University, Pekarska 53, Brno, Czech Republic. 7. Center for Medical Biochemistry, School of Pharmacy University of Belgrade, Clinical Center of Serbia, Belgrade, Serbia. 8. Institute for Medical Statistics and Informatics, Belgrade, Serbia.
Abstract
AIMS: The objective of the present substudy was to examine whether aspirin poor/high responsiveness (APR/AHR) is associated with increased rates of major adverse cardiovascular events (MACE) and serious bleeding after primary percutaneous coronary intervention (PPCI). METHODS: We analyzed 961 consecutive ST-elevation acute myocardial infarction patients who underwent PPCI between February 2008 and June 2011. Multiplate analyser (Dynabite, Munich, Germany) was used for the assessment of platelet reactivity. APR/AHR were defined as the upper/lower quintiles of ASPI values, determined 24 h after aspirin loading. APR patients were tailored using 300 mg maintenance dose for 30 days. The co-primary end points at 30 days were: MACE (death, non-fatal infarction, ischemia-driven target vessel revascularization and ischemic stroke) and serious bleeding according to the BARC classification. RESULTS: One hundred and 90 patients were classified as APR, and 193 patients as AHR. At admission, compared with aspirin sensitive patients (ASP), patients with APR had more frequently diabetes, anterior infarction and heart failure, while AHR patients had reduced values of creatine kinase, leukocytes, heart rate and systolic blood pressure. Compared with ASP, the rates of 30-day primary end points did not differ neither in APR group including tailored patients (MACE, adjusted OR 1.02, 95%CI 0.47-2.17; serious bleeding, adjusted OR 1.92, 95%CI 0.79-4.63), nor in patients with AHR (MACE, adjusted OR 1.58, 95%CI 0.71-5.51; serious bleeding, adjusted OR 0.69, 95%CI 0.22-2.12). CONCLUSIONS: The majority of APR patients were suitable for tailoring. Neither APR including tailored patients nor AHR were associated with adverse 30-day efficacy or safety clinical outcomes.
AIMS: The objective of the present substudy was to examine whether aspirin poor/high responsiveness (APR/AHR) is associated with increased rates of major adverse cardiovascular events (MACE) and serious bleeding after primary percutaneous coronary intervention (PPCI). METHODS: We analyzed 961 consecutive ST-elevation acute myocardial infarctionpatients who underwent PPCI between February 2008 and June 2011. Multiplate analyser (Dynabite, Munich, Germany) was used for the assessment of platelet reactivity. APR/AHR were defined as the upper/lower quintiles of ASPI values, determined 24 h after aspirin loading. APRpatients were tailored using 300 mg maintenance dose for 30 days. The co-primary end points at 30 days were: MACE (death, non-fatal infarction, ischemia-driven target vessel revascularization and ischemic stroke) and serious bleeding according to the BARC classification. RESULTS: One hundred and 90 patients were classified as APR, and 193 patients as AHR. At admission, compared with aspirin sensitive patients (ASP), patients with APR had more frequently diabetes, anterior infarction and heart failure, while AHRpatients had reduced values of creatine kinase, leukocytes, heart rate and systolic blood pressure. Compared with ASP, the rates of 30-day primary end points did not differ neither in APR group including tailored patients (MACE, adjusted OR 1.02, 95%CI 0.47-2.17; serious bleeding, adjusted OR 1.92, 95%CI 0.79-4.63), nor in patients with AHR (MACE, adjusted OR 1.58, 95%CI 0.71-5.51; serious bleeding, adjusted OR 0.69, 95%CI 0.22-2.12). CONCLUSIONS: The majority of APRpatients were suitable for tailoring. Neither APR including tailored patients nor AHR were associated with adverse 30-day efficacy or safety clinical outcomes.
Authors: K Kukula; M Klopotowski; P K Kunicki; J Jamiolkowski; A Debski; P Bekta; M Polanska-Skrzypczyk; Z Chmielak; A Witkowski Journal: BMC Cardiovasc Disord Date: 2016-12-08 Impact factor: 2.298