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Rev Esp Cardiol. 2009 Feb;62(2):126-35.

Post-treatment platelet reactivity predicts long-term adverse events better than the response to clopidogrel in patients with non-ST-segment elevation acute coronary syndrome.

[Article in English, Spanish]

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1
Servicio de Cardiología, Hospital de León, León, Spain.

Abstract

INTRODUCTION AND OBJECTIVES:

Poor response to antiplatelet therapy has been associated with adverse long-term outcomes. The objective of this study is to assess the relationship between response to clopidogrel and post-treatment platelet reactivity (PPR) and 1-year major adverse cardiovascular events (MACE) in patients with non-ST segment elevation acute coronary syndrome (NSTEACS).

METHODS:

Patients with NSTEACS undergoing early coronary angiography were enrolled in this prospective, observational study. The VerifyNow analyzer was used to measure clopidogrel response and PPR immediately before coronary angiography.

RESULTS:

Of the 179 patients included (97 percutaneous coronary intervention, 21 coronary artery bypass graft), 161 (90%) completed 1-year follow-up and 18 (11%) incurred MACE: 10 deaths, 6 myocardial infarctions, 2 strokes, 5 revascularizations. Lower response to clopidogrel (31 +/- 21% vs. 43 +/- 21%; P.049) and higher PPR (204 +/- 60 vs. 155 +/- 67 platelet reaction units [PRU]; p= 0.006) were significantly associated with MACE occurrence. Multivariate analysis confirmed PPR (OR per 10-unit increase: 1.12, 95%CI: 1.01-1.24; P.020) as an independent predictor of MACE. A PPR cut-off value of 175 PRU was associated with an adjusted OR for 1-year MACE occurrence of 3.9 (95%CI: 1.2-15.4; P.024).

CONCLUSIONS:

PPR predicts adverse long-term outcomes better than response to clopidogrel in patients with NSTEACS. Patients with PPR values above 175 PRU were identified as being at higher risk for adverse long-term events.

PMID:
19232185
[Indexed for MEDLINE]
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