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HIGH PLATELET REACTIVITY IS ASSOCIATED WITH VASCULAR FUNCTION IN PATIENTS AFTER PERCUTANEOUS CORONARY INTERVENTION RECEIVING CLOPIDOGREL
A1596 JACC March 17, 2015 Volume 65, Issue 10S
Stable Ischemic Heart Disease High Platelet Reactivity Is Associated with Vascular Function in Patients after Percutaneous Coronary Intervention Receiving Clopidogrel Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 10:00 a.m.-10:45 a.m. Session Title: Antiplatelet Therapy in Stable Ischemic Heart Disease Abstract Category: 27. Stable Ischemic Heart Disease: Therapy Presentation Number: 1122-363 Authors: Gerasimos Siasos, Evangelos Oikonomou, Marina Zaromitidou, Stamatios Kioufis, Manolis Vavuranakis, Konstantinos Maniatis, Eleni Kokkou, Konstantinos Mourouzis, Sotirios Tsalamandris, Theodoros Zografos, Nikolaos Papageorgiou, Athanasios Papavassiliou, Christodoulos I Stefanadis, Dimitris Tousoulis, University of Athens Medical School, 1st Cardiology Department, “Hippokration” Hospital, Athens, Greece
Background: Uncertainty exists concerning the factors affecting platelet reactivity in patients after percutaneous coronary intervention treated with clopidogrel regimen. We evaluated the association of platelet reactivity with endothelial function and arterial stiffness in patients after percutaneous coronary intervention receiving clopidogrel treatment.
Methods: We enrolled 150 patients with stable CAD receiving clopidogrel regimen (75mg/d), one month after percutaneous coronary intervention. Endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery, carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as an index of arterial wave reflections. High on treatment platelet reactivity (HPR) was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU) and the diagnostic cut-off value is 230 PRU. Patients were evaluated prospectively up to 24 months. The primary end point was a composite of death from cardiovascular causes, nonfatal major cardiovascular events and hospitalization for cardiovascular causes.
Results: There was no difference in the basic clinical and demographic characteristics between subjects with HPR and non-HPR. Subjects with high on treatment platelet reactivity and PRU>230 had significantly increased PWV (8.81±2.25m/sec vs. 7.69±1.95m/sec, p=0.001), AIx (25.27±8.67% vs. 20.87±10.57%, p=0.04) and impaired FMD (4.54±1.97% vs. 6.77±3.35%, p=0.005) compared to subjects with PRU≤230. PRU was also associated with PWV (r=0.23, p=0.02) and inversely associated FMD (r=-0.265, p=0.02). HPR was associated with significantly increased risk of primary end point [HR=5.38, 95%CI:(1.15, 26.04), p=0.03]. Conclusion: Increased platelet reactivity is associated with impaired endothelial function and arterial stifness in patients after percutaneous coronary intervention receiving clopidogrel treatment, highlighting another clinical factor implicated in individual platelet response to antiplatelet therapy. Moreover, increased platelet reactivity is associated with adverse outcome in these patients.
Stable Ischemic Heart Disease High Platelet Reactivity Is Associated with Vascular Function in Patients after Percutaneous Coronary Intervention Receiving Clopidogrel Poster Contributions Poster Hall B1 Saturday, March 14, 2015, 10:00 a.m.-10:45 a.m. Session Title: Antiplatelet Therapy in Stable Ischemic Heart Disease Abstract Category: 27. Stable Ischemic Heart Disease: Therapy Presentation Number: 1122-363 Authors: Gerasimos Siasos, Evangelos Oikonomou, Marina Zaromitidou, Stamatios Kioufis, Manolis Vavuranakis, Konstantinos Maniatis, Eleni Kokkou, Konstantinos Mourouzis, Sotirios Tsalamandris, Theodoros Zografos, Nikolaos Papageorgiou, Athanasios Papavassiliou, Christodoulos I Stefanadis, Dimitris Tousoulis, University of Athens Medical School, 1st Cardiology Department, “Hippokration” Hospital, Athens, Greece
Background: Uncertainty exists concerning the factors affecting platelet reactivity in patients after percutaneous coronary intervention treated with clopidogrel regimen. We evaluated the association of platelet reactivity with endothelial function and arterial stiffness in patients after percutaneous coronary intervention receiving clopidogrel treatment.
Methods: We enrolled 150 patients with stable CAD receiving clopidogrel regimen (75mg/d), one month after percutaneous coronary intervention. Endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery, carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as an index of arterial wave reflections. High on treatment platelet reactivity (HPR) was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU) and the diagnostic cut-off value is 230 PRU. Patients were evaluated prospectively up to 24 months. The primary end point was a composite of death from cardiovascular causes, nonfatal major cardiovascular events and hospitalization for cardiovascular causes.
Results: There was no difference in the basic clinical and demographic characteristics between subjects with HPR and non-HPR. Subjects with high on treatment platelet reactivity and PRU>230 had significantly increased PWV (8.81±2.25m/sec vs. 7.69±1.95m/sec, p=0.001), AIx (25.27±8.67% vs. 20.87±10.57%, p=0.04) and impaired FMD (4.54±1.97% vs. 6.77±3.35%, p=0.005) compared to subjects with PRU≤230. PRU was also associated with PWV (r=0.23, p=0.02) and inversely associated FMD (r=-0.265, p=0.02). HPR was associated with significantly increased risk of primary end point [HR=5.38, 95%CI:(1.15, 26.04), p=0.03]. Conclusion: Increased platelet reactivity is associated with impaired endothelial function and arterial stifness in patients after percutaneous coronary intervention receiving clopidogrel treatment, highlighting another clinical factor implicated in individual platelet response to antiplatelet therapy. Moreover, increased platelet reactivity is associated with adverse outcome in these patients.