Relationship between Clopidogrel-Induced Platelet P2Y12 Inhibition and Stent Thrombosis or Myocardial Infarction after Percutaneous Coronary Intervention: A Case-Control Study
2011 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 162, no 2, 363-371 p.Article in journal (Refereed) Published
Aims: Platelet inhibition levels were investigated in patients with previous angiographically confirmed stent thrombosis (ST), myocardial infarction (MI) and controls.
Methods and Results: Using The Swedish Coronary Angiography and Angioplasty Registry we identified patients with angiographically confirmed ST (n=48) or MI (n=30) while on dual antiplatelet therapy within 6 months of percutaneous coronary intervention (PCI) and matched control patients (n=78) with none of these events in the same setting. On-clopidogrel platelet reactivity was measured with VerifyNow™ P2Y12 and vasodilator stimulated phosphoprotein phosphorylation (VASP-P) assay.
The mean P2Y12 reaction units (PRU) was higher (246.8 ± 75.9 vs. 200.0 ± 82.7, p=0.001) in ST patients compared to controls. The optimal cut-off for ST was ≥222 PRU (area under the curve 0.69, p<0.0001) in a receiver operating characteristics (ROC) analysis, which was identical to the cut-off level defined as the proportion of controls below the 30th percentile of P2Y12 inhibition distribution in patients with ST. The cut-off level resulted in 70.2% sensitivity and 67.3% specificity. There was no significant difference in mean PRU but a higher device-reported % inhibition (45.1 ± 23.8 vs 32.1 ± 23.2, p=0.04) in patients with MI compared to controls. Results with the VASP-P assay were not related to the occurrence of ST or MI.
Conclusion: Stent thrombosis was associated with high on-clopidogrel platelet reactivity measured with VerifyNow™. Spontaneous MI in stented patients on clopidogrel treatment was not. There was, however, a substantial overlap in clopidogrel platelet reactivity response between patients with and without on-treatment ST.
Place, publisher, year, edition, pages
2011. Vol. 162, no 2, 363-371 p.
clopidogrel, acute coronary syndromes, coronary artery disease, stent thrombosis, VerifyNow™, VASP, clopidogrel poor response
klopidogrel, akuta koronara syndrom, hjärtinfarkt, stenttrombos
Cardiac and Cardiovascular Systems
Research subject Cardiology
IdentifiersURN: urn:nbn:se:uu:diva-131953DOI: 10.1016/j.ahj.2011.06.003ISI: 000293729400021OAI: oai:DiVA.org:uu-131953DiVA: diva2:356241