Point-of-Care Assessment of Platelet Reactivity After Clopidogrel to Predict Myonecrosis in Patients Undergoing Percutaneous Coronary Intervention

• Published in: JACC. Cardiovascular interventions Vol. 3; no. 3; pp. 318 - 323
• Main Authors: Mangiacapra, Fabio, MD, Barbato, Emanuele, MD, PhD, Patti, Giuseppe, MD, Gatto, Laura, MD, Vizzi, Vincenzo, MD, Ricottini, Elisabetta, MD, D'Ambrosio, Andrea, MD, Wijns, William, MD, PhD, Di Sciascio, Germano, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2010
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Biomarkers - blood; Blood Platelets - drug effects; Blood Platelets - metabolism; Cardiovascular; Coronary Artery Disease - blood; Coronary Artery Disease - therapy; Creatine Kinase, MB Form - blood; Female; high platelet reactivity; Humans; Logistic Models; Male; Middle Aged; myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - etiology; Myocardial Infarction - pathology; Myocardial Infarction - prevention & control; Myocardium - pathology; Necrosis; Odds Ratio; percutaneous coronary intervention; Platelet Aggregation Inhibitors - therapeutic use; Platelet Function Tests; point-of-care platelet function test; Point-of-Care Systems; Predictive Value of Tests; Purinergic P2 Receptor Antagonists; Receptors, Purinergic P2 - blood; Receptors, Purinergic P2Y12; Risk Assessment; Risk Factors; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Time Factors; Treatment Outcome; Troponin I - blood; periprocedural myocardial infarction; high platelet reactivity; myocardial infarction; CK-MB; troponin I; HPR; PMI; Tn-I; percutaneous coronary intervention; PRU; upper limit of normal; point-of-care platelet function test; ULN; PCI; creatine kinase-myocardial band; P2Y12 reaction units
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2009.12.012

Objectives We sought to evaluate the influence of platelet reactivity after clopidogrel, as assessed by the VerifyNow point-of-care assay (Accumetrics, San Diego, California), on myonecrosis in low-to-intermediate risk patients undergoing percutaneous coronary intervention (PCI). Background Inadequate platelet inhibition at the time of PCI is associated with a higher risk of recurrent ischemic events. Methods A total of 250 consecutive biomarker-negative patients treated with clopidogrel and undergoing elective PCI were enrolled. Cardiac biomarkers (creatine kinase-myocardial band and troponin I) were measured before and 8 and 24 h after intervention. Platelet reactivity after clopidogrel was assessed immediately before PCI by the VerifyNow P2Y12 point-of-care assay. High platelet reactivity (HPR) after clopidogrel was defined as a platelet reaction unit value ≥240. Results Patients with HPR (31% of the overall population) showed more frequent myonecrosis, with statistical significance with regard to creatine kinase-myocardial band elevation (35% vs. 20%; p = 0.011), and by trend with regard to troponin-I elevation (47% vs. 35%; p = 0.059). Incidence of periprocedural myocardial infarction was higher in patients with HPR, both by creatine kinase-myocardial band (13% vs. 4%; p = 0.011) and troponin-I definition (32% vs. 19%; p = 0.019). By multivariable analysis, HPR was an independent predictor of periprocedural myocardial infarction. Conclusions Easily assessed by a point-of-care assay, HPR after clopidogrel is a frequent finding and is associated with increased risk of myonecrosis in low-to-intermediate risk patients undergoing planned PCI.