Roberta De Rosa1, Tullio Palmerini2, Stefano De Servi3, Marta Belmonte1, Gabriele Crimi3, Stefano Cornara3, Paolo Calabrò4, Marco Cattaneo5, Diego Maffeo6, Anna Toso7, Antonio Bartorelli8, Cataldo Palmieri8, Marco De Carlo9, Davide Capodanno10, Philippe Genereux11, Dominick Angiolillo12, Federico Piscione13, Gennaro Galasso1. 1. Department of Cardiology, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy. 2. Cardiovascular Department, Policlinico S. Orsola, Bologna, Italy. 3. Cardiology and Coronary Care Unit, Policlinico S. Matteo, Pavia, Italy. 4. Department of Cardiovascular Science, Second University of Naples, AO dei Colli, Monaldi, Napoli, Italy. 5. Department of Health Science, University of Milan, Milano, Italy. 6. Cardiothoracic Department, Spedali Civili di Brescia, Brescia, Italy. 7. Division of Cardiology, Prato Hospital, Prato, Italy. 8. Monzino Heart Center, Milano, Italy. 9. Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy. 10. Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy. 11. Columbia University Medical Center and the Cardiovascular Research Foundation, New York, United States. 12. Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, United States. 13. Department of Cardiology, San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy. Electronic address: fpiscione@unisa.it.
Abstract
BACKGROUND: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI. METHODS: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel. Major adverse cardiac events (MACE) were assessed up to 1 year-follow-up. RESULTS: Elderly with HPR at discharge showed a significantly higher incidence of overall MACE (13 vs 4%, p = .006), cardiac death (6 vs 0.7%, p = .020), myocardial infarction (MI, 12 vs 4%, p = .031) and a trend for higher stent-thrombosis (5 vs 0.7%, p = .068). Similarly, elderly with 1-month-HPR showed between 1 month and 1 year significantly higher incidence of MACE (10 vs 4%, p = .012), cardiac death (6 vs 0.7%, p = .019) and composite cardiac death/MI (11 vs 4%, p = .014). Up to 1 year, elderly with HPR showed a 4-fold increased risk of MACE compared to both elderly without HPR (for discharge-HPR: p = .005; for 1-month-HPR: p = .01) and non-elderly with HPR (for discharge-HPR: p < .001; for 1-month-HPR: p < .0001). At multivariable analysis, HPR could independently predict 1-year-MACE in elderly (for discharge-HPR: HR = 3.191, CI: 1.373-7.417, p = .007; for 1-month-HPR: HR = 3.542, CI: 1.373-9.137, p = .009). CONCLUSIONS: In elderly with NSTE-ACS undergoing PCI and treated with clopidogrel, HPR was independently associated with an increased risk of MACE up to 1 year.
BACKGROUND: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI. METHODS: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel. Major adverse cardiac events (MACE) were assessed up to 1 year-follow-up. RESULTS: Elderly with HPR at discharge showed a significantly higher incidence of overall MACE (13 vs 4%, p = .006), cardiac death (6 vs 0.7%, p = .020), myocardial infarction (MI, 12 vs 4%, p = .031) and a trend for higher stent-thrombosis (5 vs 0.7%, p = .068). Similarly, elderly with 1-month-HPR showed between 1 month and 1 year significantly higher incidence of MACE (10 vs 4%, p = .012), cardiac death (6 vs 0.7%, p = .019) and composite cardiac death/MI (11 vs 4%, p = .014). Up to 1 year, elderly with HPR showed a 4-fold increased risk of MACE compared to both elderly without HPR (for discharge-HPR: p = .005; for 1-month-HPR: p = .01) and non-elderly with HPR (for discharge-HPR: p < .001; for 1-month-HPR: p < .0001). At multivariable analysis, HPR could independently predict 1-year-MACE in elderly (for discharge-HPR: HR = 3.191, CI: 1.373-7.417, p = .007; for 1-month-HPR: HR = 3.542, CI: 1.373-9.137, p = .009). CONCLUSIONS: In elderly with NSTE-ACS undergoing PCI and treated with clopidogrel, HPR was independently associated with an increased risk of MACE up to 1 year.
Authors: Gabriele Crimi; Nuccia Morici; Maurizio Ferrario; Luca A Ferri; Luigi Piatti; Daniele Grosseto; Michele Cacucci; Alessandro Mandurino Mirizzi; Anna Toso; Federico Piscione; Marco De Carlo; Luigi Raffaele Elia; Bruno Trimarco; Leonardo Bolognese; Francesco M Bovenzi; Giuseppe De Luca; Stefano Savonitto; Stefano De Servi Journal: J Am Heart Assoc Date: 2019-01-22 Impact factor: 5.501
Authors: Matej Samoš; Ingrid Škorňová; Tomáš Bolek; Lucia Stančiaková; Barbora Korpallová; Peter Galajda; Ján Staško; Peter Kubisz; Marián Mokáň Journal: Diagnostics (Basel) Date: 2021-01-19