High residual platelet reactivity after clopidogrel: extent of coronary atherosclerosis and periprocedural myocardial infarction in patients with stable angina undergoing percutaneous coronary intervention.

Details

Serval ID
serval:BIB_A157CCC0E8DF
Type
Article: article from journal or magazin.
Collection
Publications
Title
High residual platelet reactivity after clopidogrel: extent of coronary atherosclerosis and periprocedural myocardial infarction in patients with stable angina undergoing percutaneous coronary intervention.
Journal
Jacc. Cardiovascular Interventions
Author(s)
Mangiacapra F., De Bruyne B., Muller O., Trana C., Ntalianis A., Bartunek J., Heyndrickx G., Di Sciascio G., Wijns W., Barbato E.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
3
Number
1
Pages
35-40
Language
english
Abstract
OBJECTIVES: We tested the hypothesis that residual platelet reactivity after clopidogrel correlates with the extent and severity of coronary atherosclerosis in patients undergoing elective percutaneous coronary intervention (PCI).
BACKGROUND: Platelets are actively involved in vascular atherosclerosis.
METHODS: We prospectively enrolled 338 patients undergoing PCI for stable angina, loaded with 600-mg clopidogrel. Platelet reactivity was assessed 12 h later by measuring P2Y12 reactivity unit (PRU) with VerifyNow P2Y12 assay (Accumetrics, San Diego, California). High platelet reactivity (HPR) was defined as PRU value >or=240. Presence of multivessel disease (MVD) and total stent length (TSL) were used as surrogate markers of atherosclerosis severity and extension.
RESULTS: Patients with MVD showed higher PRU compared with single-vessel disease (SVD) patients (222 +/- 85 vs. 191 +/- 73; p < 0.001). The PRU increased with the number of stenotic coronaries (1-vessel disease: 191 +/- 73; 2-vessel disease: 220 +/- 88; 3-vessel disease: 226 +/- 80; p = 0.002). The PRU was higher in the third TSL tertile compared with first tertile (217 +/- 83 vs. 191 +/- 73; p = 0.048). The HPR was most frequently observed among MVD patients (40.5% vs. 21.6% in patients with SVD, respectively; p < 0.001) and those in the third TSL tertile (35.8% vs. 22.2% first tertile; p = 0.028). Higher incidence of periprocedural myocardial infarction was observed in patients with HPR (41.2% vs. 26.7% in patients without HPR; p = 0.008) and in those in the third tertile TSL (37.7% vs. 23.1% first tertile; p = 0.020). By multivariate analysis, HPR was the only independent predictor of periprocedural myocardial infarction (p = 0.034).
CONCLUSIONS: Patients with more extensive coronary atherosclerosis have a higher rate of HPR, which might partly account for higher risk of periprocedural MI.
Keywords
Aged, Angina Pectoris/blood, Angina Pectoris/etiology, Angioplasty, Balloon, Coronary/adverse effects, Angioplasty, Balloon, Coronary/instrumentation, Blood Platelets/drug effects, Blood Platelets/metabolism, Coronary Angiography, Coronary Artery Disease/blood, Coronary Artery Disease/complications, Drug Resistance, Female, Humans, Male, Middle Aged, Myocardial Infarction/blood, Myocardial Infarction/etiology, Platelet Aggregation/drug effects, Platelet Aggregation Inhibitors/therapeutic use, Prospective Studies, Purinergic P2 Receptor Antagonists, Receptors, Purinergic P2/blood, Receptors, Purinergic P2Y12, Risk Assessment, Risk Factors, Severity of Illness Index, Stents, Ticlopidine/analogs & derivatives, Ticlopidine/therapeutic use, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
16/02/2015 18:00
Last modification date
20/08/2019 15:07
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