Korean Circ J.  2012 Jun;42(6):382-389. 10.4070/kcj.2012.42.6.382.

Impact of Platelet Function Test on Platelet Responsiveness and Clinical Outcome After Coronary Stent Implantation: Platelet Responsiveness and Clinical Outcome

• Yu LH
• Kim MH
• Zhang HZ
• Park JS
• Park TH
• Kim YD
• Cha KS
• Han JY

• KMID: 1433857
• DOI: http://doi.org/10.4070/kcj.2012.42.6.382

Abstract

BACKGROUND AND OBJECTIVES
The aim of this study was to confirm the predictive cut-off values for P2Y12 reaction units (PRU) and aspirin reaction units (ARU) and to evaluate the clinical impact of VerifyNow(R) assays.
SUBJECTS AND METHODS
From November 2007 to October 2009, 186 eligible patients were prospectively recruited. Post-treatment platelet reactivity was measured by VerifyNow(R) assays within 12 to 24 hours after intervention, followed by standard dual maintenance dose therapy for 1 year. All patients had scheduled clinical follow-ups at 1, 3, 6, and 12 months.
RESULTS
The rate of low responders to clopidogrel, aspirin, and both drugs were 41.4%, 10.2%, and 3.8%, respectively. The predictive factors for low responsiveness to clopidogrel (PRU > or =240) were female sex, age, and non-use of cilostazol medication in our univariate analysis and age > or =65 years and non-use cilostazol in the multivariate analysis. The predictors of low responsiveness to aspirin (ARU > or =550) were male sex and age in both univariate and multivariate analyses. There was no significant difference in the clinical event rate with a cut-off value of PRU > or =240 or ARU > or =550 for 30 days and 1-year (p>0.05).
CONCLUSION
Hyporesponsiveness to antiplatelet agents (namely aspirin and clopidogrel) was identified in about half of the patients. The cut-off point of PRU > or =240 or ARU > or =550 did not confer predictive value for 30-day or 1-year clinical event rates in patients who had undergone coronary intervention with drug-eluting stents.

Keyword

Platelet function tests; Coronary artery disease; Drug-eluting stents

MeSH Terms

Aspirin
Blood Platelets
Coronary Artery Disease
Drug-Eluting Stents
Female
Follow-Up Studies
Humans
Male
Multivariate Analysis
Platelet Aggregation Inhibitors
Platelet Function Tests
Prospective Studies
Stents
Tetrazoles
Ticlopidine
Aspirin
Platelet Aggregation Inhibitors
Tetrazoles
Ticlopidine

Figure

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  Fig. 1 Study flow diagram. PCI: percutaneous coronary intervention, MACCE: major adverse cardiac and cerebrovascular events.

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  Fig. 2 Statistical distributions of the study patients by VerifyNow® assays. A: P2Y12 reaction units (PRU). B: aspirin reaction units (ARU).

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  Fig. 3 Correlation, concordance rate, and distribution plot of 1-year MACCE in regards to ARU and PRU values. ARU: aspirin reaction units, MACCE: major adverse cardiac and cerebrovascular events, PRU: P2Y12 reaction units.

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  Fig. 4 Receiver operating characteristic curve analysis of 30 day MACCE. PRU and ARU values did not enable the ability to predict 30 day MACCE. ARU: aspirin reaction units, MACCE: major adverse cardiac and cerebrovascular events, PRU: P2Y12 reaction units.

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  Fig. 5 One-year MACCE curve for responders and low responders. There was no significant difference in PRU <240 vs. PRU ≥240 (upper) or PRU ≥240 or ARU ≥550 vs. PRU <240 and ARU <550 (lower). ARU: aspirin reaction units, MACCE: major adverse cardiac and cerebrovascular events, PRU: P2Y12 reaction units.

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