Yu Luo1, Jimin Li1, Xu Liu2, Jianfeng Xu3, Zi Ye1, Yian Yao1, Xuebo Liu1, Yan Lai4. 1. Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. 2. State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China; Fudan Center for Genetic Epidemiology, School of Life Sciences, Fudan University, Shanghai, China. 3. State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China; Fudan Center for Genetic Epidemiology, School of Life Sciences, Fudan University, Shanghai, China; Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Center for Genomic Translational Medicine and Prevention, School of Public Health, Fudan University, Shanghai, China; NorthShore Research Institute, NorthShore University Health System, Evanston, IL, USA. 4. Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: ljm_ly@126.com.
Abstract
INTRODUCTION: High on-treatment platelet reactivity is a well-known risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). This study was to investigate the value of a novel platelet reactivity-based system, named the COP-INH (COmbination of P2Y12 reaction unit [PRU] and percentage of platelet inhibition [%INH]), assessed by VerifyNow P2Y12 assay, for predicting the long-term ischaemic events in patients with acute coronary syndrome (ACS) undergoing PCI. MATERIALS AND METHODS: The COP-INH was calculated on the basis of data obtained at 30days after PCI: patients with both an elevated PRU (≥230) and decreased %INH (<40%) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. The primary endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization at 1year follow-up. The relationship between the COP-INH score and primary endpoint was analyzed. RESULTS: 207 patients were enrolled. Baseline characteristics were similar between patients with COP-INH=2 and patients with COP-INH=1 or 0, except for diabetes mellitus (43.8% vs. 21.7%, p=0.015) and previous coronary artery bypass grafting (CABG) (21.9% vs. 6.86%, p=0.007). During the observation period, the incidence of major adverse cardiovascular events (MACE) in patients with COP-INH=2 was significantly higher than patients with COP-INH=1 or 0 (18.8% vs. 4.6%, p=0.007). Multivariate analysis of clinical characteristics and platelet reactivity selected by univariate analysis showed that the COP-INH=2 was an independent predictor of MACE in patients with ACS undergoing PCI (OR 2.745; 95% CI 1.369-9.851; p=0.024), whereas neither PRU≥230 nor %INH<40% was. CONCLUSION: The COP-INH is considered to be a useful predictor of long-term ischaemic events of patients with ACS undergoing PCI.
INTRODUCTION: High on-treatment platelet reactivity is a well-known risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). This study was to investigate the value of a novel platelet reactivity-based system, named the COP-INH (COmbination of P2Y12 reaction unit [PRU] and percentage of platelet inhibition [%INH]), assessed by VerifyNow P2Y12 assay, for predicting the long-term ischaemic events in patients with acute coronary syndrome (ACS) undergoing PCI. MATERIALS AND METHODS: The COP-INH was calculated on the basis of data obtained at 30days after PCI: patients with both an elevated PRU (≥230) and decreased %INH (<40%) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. The primary endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization at 1year follow-up. The relationship between the COP-INH score and primary endpoint was analyzed. RESULTS: 207 patients were enrolled. Baseline characteristics were similar between patients with COP-INH=2 and patients with COP-INH=1 or 0, except for diabetes mellitus (43.8% vs. 21.7%, p=0.015) and previous coronary artery bypass grafting (CABG) (21.9% vs. 6.86%, p=0.007). During the observation period, the incidence of major adverse cardiovascular events (MACE) in patients with COP-INH=2 was significantly higher than patients with COP-INH=1 or 0 (18.8% vs. 4.6%, p=0.007). Multivariate analysis of clinical characteristics and platelet reactivity selected by univariate analysis showed that the COP-INH=2 was an independent predictor of MACE in patients with ACS undergoing PCI (OR 2.745; 95% CI 1.369-9.851; p=0.024), whereas neither PRU≥230 nor %INH<40% was. CONCLUSION: The COP-INH is considered to be a useful predictor of long-term ischaemic events of patients with ACS undergoing PCI.