High residual platelet reactivity after clopidogrel: extent of coronary atherosclerosis and periprocedural myocardial infarction in patients with stable angina undergoing percutaneous coronary intervention.
Détails
ID Serval
serval:BIB_A157CCC0E8DF
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
High residual platelet reactivity after clopidogrel: extent of coronary atherosclerosis and periprocedural myocardial infarction in patients with stable angina undergoing percutaneous coronary intervention.
Périodique
Jacc. Cardiovascular Interventions
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Statut éditorial
Publié
Date de publication
2010
Peer-reviewed
Oui
Volume
3
Numéro
1
Pages
35-40
Langue
anglais
Résumé
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.
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.
Mots-clé
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
Oui
Création de la notice
16/02/2015 19:00
Dernière modification de la notice
20/08/2019 16:07