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Cited by 651Antiplatelet Therapy and Cardiovascular DiseasesCoronary Interventions and DiagnosticsAcute Myocardial Infarction Research

Prognostic significance of post-clopidogrel platelet reactivity assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation

Price, Matthew J., Endemann, Sarah, Gollapudi, Raghava R., Valencia, Rafael, Stinis, Curtiss T., Levisay, Justin P., Ernst, Alissa, Sawhney, Neil S. +2 more·2008·European Heart Journal
DOI 10.1093/eurheartj/ehn046
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Abstract

AIMS: The aim of this study was to determine whether platelet reactivity on clopidogrel therapy, as measured by a point-of-care platelet function assay, is associated with thrombotic events after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs). METHODS AND RESULTS: Platelet reactivity on clopidogrel (post-treatment reactivity) was measured with the VerifyNow P2Y12 assay (Accumetrics Inc., San Diego, CA, USA) in 380 patients undergoing PCI with sirolimus-eluting stents. Receiver-operating characteristic curve analysis was used to derive the optimal cut-off value for post-treatment reactivity in predicting 6 month out-of-hospital cardiovascular (CV) death, non-fatal MI, or stent thrombosis. The mean post-treatment reactivity was 184 +/- 85 PRU (P2Y12 reaction units). The optimal cut-off for the combined endpoint was a post-treatment reactivity > or =235 PRU [area under the curve 0.711 (95% confidence interval 0.529-0.893), P = 0.03], which was similar to the threshold of the upper tertile (231 PRU). Patients with post-treatment reactivity greater than the cut-off value had significantly higher rates of CV death (2.8 vs. 0%, P = 0.04), stent thrombosis (4.6 vs. 0%, P = 0.004), and the combined endpoint (6.5 vs. 1.0%, P = 0.008). CONCLUSION: High post-treatment platelet reactivity measured with a point-of-care platelet function assay is associated with post-discharge events after PCI with DES, including stent thrombosis. Investigation of alternative clopidogrel dosing regimens to reduce ischaemic events in high-risk patients identified by this assay is warranted.

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Sorted by citations

Authors
Price, M. J., Endemann, S., Gollapudi, R. R., Valencia, R., Stinis, C. T., Levisay, J. P., Ernst, A., Sawhney, N. S., Schatz, R. A., & Teirstein, P. S.
Affiliations
Scripps Clinic (US)
Corresponding author
Price, Matthew J.
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2008-02-10
Volume
29
Issue
8
Pages
992-1000
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehn046
OpenAlex
W2165620610
Cited by
651
References
0
Citations by year
2026: 7 · 2025: 4 · 2024: 8 · 2023: 8 · 2022: 12 · 2021: 5 · 2020: 12 · 2019: 17 · 2018: 21 · 2017: 15 · 2016: 24 · 2015: 55 · 2014: 43 · 2013: 57 · 2012: 68
FWCI
72.07
Type
journal article
Language
en
Open access
closed
Locations
  • European Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
  • Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
clopidogrel, platelet reactivity, VerifyNow P2Y12 assay, drug-eluting stents, sirolimus-eluting stent, percutaneous coronary intervention, stent thrombosis, cardiovascular mortality, myocardial infarction, prognostic factors
MeSH terms
Clopidogrel, Aged, Coronary Thrombosis, Epidemiologic Methods, Female, Humans, Male, Platelet Aggregation, Platelet Aggregation Inhibitors, Prognosis, Ticlopidine, Angioplasty, Balloon, Coronary, Point-of-Care Systems, Coronary Stenosis, Drug-Eluting Stents

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