- Email: [email protected]
DUAL PLATELET REACTIVITY TESTING IN ACUTE CORONARY SYNDROME
530 JACC April 5, 2016 Volume 67, Issue 13
Acute Coronary Syndromes DUAL PLATELET REACTIVITY TESTING IN ACUTE CORONARY SYNDROME Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: Acute Coronary Syndromes: Managing Dilemmas in Antithrombotic Therapy Abstract Category: 15. Acute Coronary Syndromes: Therapy Presentation Number: 1133-010 Authors: Mark Y.Y. Chan, Leonardo Carvalho, Alan Fong, Chee Tang Chin, Sock Cheng Poh, Christopher Frampton, Chi-Hang Lee, Adrian Low, Huay-Cheem Tan, Richard Troughton, Bryan P. Yan, Siew-Pang Chan, Mark Richards, National University Heart Centre, Singapore, Singapore Background: Platelet reactivity (PR) testing has prognostic value in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). There are conflicting data on the optimal type and timing of PR testing. We investigated the prognostic value of high on-aspirin PR (ASPR) and high on-ADP receptor antagonist PR (ADPR), performed before and after PCI, in ACS patients on dual antiplatelet therapy.
Methods: We measured ASPR and ADPR using the Multiplate ASPI (arachidonic acid agonist) and ADP (adenosine diphosphate agonist) tests respectively, immediately before (initial test) and 24-48 hours after (final test) angiography and PCI. All patients were monitored for intra-procedural thrombotic events, as defined in the Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial, 30-day and 12-month major adverse cardiovascular and cerebrovascular events (MACCE). Results: Out of 928 patients with ACS, all patients received low-dose aspirin (100 mg daily), 82.5% received clopidogrel (75 mg daily), 11.6% received ticagrelor (180 mg daily) and 5.8% received prasugrel (10 mg daily) for 12 months. Intraprocedural thrombotic events occurred in 15 patients (2.4%), MACCE occurred in 26 pts (2.8%) at 30-days and 90 patients (9.7%) at 12-months. Patients with and without high initial ASPR (ASPI test ≥ 300 AU*min) had, respectively, an intraprocedural thrombotic event incidence of 8.6% versus 1.2% (P=<0.001), 30-day MACCE incidence of 5.2% versus 2.3% (P=0.05) and 12-month MACCE incidence of 9.8% versus 10.5% (P=0.5). Patients with and without high initial ADPR (ADP test ≥ 468 AU*min) had, respectively, an intraprocedural thrombotic event incidence of 4.4% versus 0.9% (P=0.001), 30-day MACCE incidence of 3.5% vs. 2.3% (P=0.2) and 12-month MACCE of 11.1% versus 8.4% (P=0.6). Neither high final ASPR nor ADPR was associated with 30-day or 12-month MACCE. The adjusted hazard ratio of high initial ASPR and ADPR for intraprocedural thrombotic events was 7.46 (2.54−21.90) and 5.01 (1.38−18.18), respectively. Conclusions: High pre-procedure ASPR and ADPR predict intraprocedural thrombotic events in ACS patients undergoing PCI.
Acute Coronary Syndromes DUAL PLATELET REACTIVITY TESTING IN ACUTE CORONARY SYNDROME Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m. Session Title: Acute Coronary Syndromes: Managing Dilemmas in Antithrombotic Therapy Abstract Category: 15. Acute Coronary Syndromes: Therapy Presentation Number: 1133-010 Authors: Mark Y.Y. Chan, Leonardo Carvalho, Alan Fong, Chee Tang Chin, Sock Cheng Poh, Christopher Frampton, Chi-Hang Lee, Adrian Low, Huay-Cheem Tan, Richard Troughton, Bryan P. Yan, Siew-Pang Chan, Mark Richards, National University Heart Centre, Singapore, Singapore Background: Platelet reactivity (PR) testing has prognostic value in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). There are conflicting data on the optimal type and timing of PR testing. We investigated the prognostic value of high on-aspirin PR (ASPR) and high on-ADP receptor antagonist PR (ADPR), performed before and after PCI, in ACS patients on dual antiplatelet therapy.
Methods: We measured ASPR and ADPR using the Multiplate ASPI (arachidonic acid agonist) and ADP (adenosine diphosphate agonist) tests respectively, immediately before (initial test) and 24-48 hours after (final test) angiography and PCI. All patients were monitored for intra-procedural thrombotic events, as defined in the Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial, 30-day and 12-month major adverse cardiovascular and cerebrovascular events (MACCE). Results: Out of 928 patients with ACS, all patients received low-dose aspirin (100 mg daily), 82.5% received clopidogrel (75 mg daily), 11.6% received ticagrelor (180 mg daily) and 5.8% received prasugrel (10 mg daily) for 12 months. Intraprocedural thrombotic events occurred in 15 patients (2.4%), MACCE occurred in 26 pts (2.8%) at 30-days and 90 patients (9.7%) at 12-months. Patients with and without high initial ASPR (ASPI test ≥ 300 AU*min) had, respectively, an intraprocedural thrombotic event incidence of 8.6% versus 1.2% (P=<0.001), 30-day MACCE incidence of 5.2% versus 2.3% (P=0.05) and 12-month MACCE incidence of 9.8% versus 10.5% (P=0.5). Patients with and without high initial ADPR (ADP test ≥ 468 AU*min) had, respectively, an intraprocedural thrombotic event incidence of 4.4% versus 0.9% (P=0.001), 30-day MACCE incidence of 3.5% vs. 2.3% (P=0.2) and 12-month MACCE of 11.1% versus 8.4% (P=0.6). Neither high final ASPR nor ADPR was associated with 30-day or 12-month MACCE. The adjusted hazard ratio of high initial ASPR and ADPR for intraprocedural thrombotic events was 7.46 (2.54−21.90) and 5.01 (1.38−18.18), respectively. Conclusions: High pre-procedure ASPR and ADPR predict intraprocedural thrombotic events in ACS patients undergoing PCI.