AIM: In percutaneous coronary intervention (PCI)-treated acute coronary syndrome (ACS) patients on clopidogrel therapy, high on-treatment platelet adenosine diphosphate (ADP) reactivity was observed in numerous studies, with significant increases in non-fatal myocardial infarction, definite/probable stent thrombosis, or cardiovascular mortality. Compared to clopidogrel, prasugrel and ticagrelor provide more potent platelet inhibition. Whether new P2Y12 inhibitors reduce thrombotic events in a similar manner compared to the rate observed with appropriate P2Y12 inhibition by clopidogrel must still be determined. This study sought to compare long-term outcomes between clopidogrel responders (platelet reactivity index [PRI] vasodilator-stimulated phosphoprotein [VASP] ＜61%) and patients under prasugrel or ticagrelor therapy following PCI-treated ACS. METHODS: 730 ACS patients undergoing urgent PCI were prospectively enrolled into two groups: clopidogrel responders (n=448) and those under ticagrelor or prasugrel therapy (n=282). The primary endpoint was a composite of cardiovascular death, myocardial infarction, stent thrombosis, and stroke; the secondary endpoint comprised major hemorrhagic events. RESULTS: The median follow-up was 260±186 days. Clopidogrel patients were older and more likely to present non-ST segment elevation myocardial infarction, cardiovascular risk factors, atrial fibrillation, or prior vascular disease. After propensity score matching, the primary endpoint was met in 7.1% of the clopidogrel group and 4.1% of the prasugrel/ticagrelor group (p=0.43). Minor bleeding events were significantly reduced in the clopidogrel group (1.1% vs. 3%; p=0.03). In a multivariate analysis, the antiplatelet treatment strategy was not an independent primary endpoint predictor. CONCLUSION: In PCI-treated ACS patients, clopidogrel therapy and PRI VASP ＜61% were not associated with increased risks of thrombotic events compared to prasugrel or ticagrelor therapy.
AIM: In percutaneous coronary intervention (PCI)-treated acute coronary syndrome (ACS) patients on clopidogrel therapy, high on-treatment platelet adenosine diphosphate (ADP) reactivity was observed in numerous studies, with significant increases in non-fatal myocardial infarction, definite/probable stent thrombosis, or cardiovascular mortality. Compared to clopidogrel, prasugrel and ticagrelor provide more potent platelet inhibition. Whether new P2Y12 inhibitors reduce thrombotic events in a similar manner compared to the rate observed with appropriate P2Y12 inhibition by clopidogrel must still be determined. This study sought to compare long-term outcomes between clopidogrel responders (platelet reactivity index [PRI] vasodilator-stimulated phosphoprotein [VASP] ＜61%) and patients under prasugrel or ticagrelor therapy following PCI-treated ACS. METHODS: 730 ACS patients undergoing urgent PCI were prospectively enrolled into two groups: clopidogrel responders (n=448) and those under ticagrelor or prasugrel therapy (n=282). The primary endpoint was a composite of cardiovascular death, myocardial infarction, stent thrombosis, and stroke; the secondary endpoint comprised major hemorrhagic events. RESULTS: The median follow-up was 260±186 days. Clopidogrelpatients were older and more likely to present non-ST segment elevation myocardial infarction, cardiovascular risk factors, atrial fibrillation, or prior vascular disease. After propensity score matching, the primary endpoint was met in 7.1% of the clopidogrel group and 4.1% of the prasugrel/ticagrelor group (p=0.43). Minor bleeding events were significantly reduced in the clopidogrel group (1.1% vs. 3%; p=0.03). In a multivariate analysis, the antiplatelet treatment strategy was not an independent primary endpoint predictor. CONCLUSION: In PCI-treated ACS patients, clopidogrel therapy and PRI VASP ＜61% were not associated with increased risks of thrombotic events compared to prasugrel or ticagrelor therapy.
Authors: Olivier Morel; Soraya El Ghannudi; Laurence Jesel; Bogdan Radulescu; Nicolas Meyer; Marie-Louise Wiesel; Sophie Caillard; Umberto Campia; Bruno Moulin; Christian Gachet; Patrick Ohlmann Journal: J Am Coll Cardiol Date: 2011-01-25 Impact factor: 24.094
Authors: Dirk Sibbing; Dániel Aradi; Claudius Jacobshagen; Lisa Gross; Dietmar Trenk; Tobias Geisler; Martin Orban; Martin Hadamitzky; Béla Merkely; Róbert Gábor Kiss; András Komócsi; Csaba A Dézsi; Lesca Holdt; Stephan B Felix; Radoslaw Parma; Mariusz Klopotowski; Robert H G Schwinger; Johannes Rieber; Kurt Huber; Franz-Josef Neumann; Lukasz Koltowski; Julinda Mehilli; Zenon Huczek; Steffen Massberg Journal: Lancet Date: 2017-08-28 Impact factor: 79.321
Authors: Dániel Aradi; Ajay Kirtane; Laurent Bonello; Paul A Gurbel; Udaya S Tantry; Kurt Huber; Matthias K Freynhofer; Jurrien ten Berg; Paul Janssen; Dominick J Angiolillo; Jolanta M Siller-Matula; Rossella Marcucci; Giuseppe Patti; Fabio Mangiacapra; Marco Valgimigli; Olivier Morel; Tullio Palmerini; Matthew J Price; Thomas Cuisset; Adnan Kastrati; Gregg W Stone; Dirk Sibbing Journal: Eur Heart J Date: 2015-04-20 Impact factor: 29.983
Authors: Tullio Palmerini; Philippe Généreux; Roxana Mehran; George Dangas; Adriano Caixeta; Diego Della Riva; Andrea Mariani; Ke Xu; Gregg W Stone Journal: Am J Cardiol Date: 2013-02-11 Impact factor: 2.778