High post-clopidogrel platelet reactivity assessed by a point-of-care assay predicts
long-term clinical outcomes in patients with ST-segment elevation myocardial
infarction who underwent primary coronary stenting
- Affiliated Author(s)
- 허승호; 남창욱
- Alternative Author(s)
- Nam, Chang Wook; Hur, Seung Ho
- Journal Title
- International Journal of Cardiology
- ISSN
- 0167-5273
- Issued Date
- 2013
- Abstract
- Background: Recent studies have shown that post-clopidogrel high platelet reactivity (HPR), assessed by a
point-of-care assay, is associated with a higher risk of adverse events after percutaneous coronary
intervention (PCI). We assessed the clinical impact of HPR by the VerifyNow P2Y12 point-of-care assay in
181 patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary PCI with
drug-eluting stents (DES) at 3 hospitals.
Methods: The primary endpoint of the study was the 12-month major adverse cardiovascular events (MACE),
which comprised cardiovascular death, nonfatal MI and ischemic stroke. All patients received a single loading
dose of 600 mg clopidogrel and 300 mg aspirin followed by a daily maintenance dose of 75 mg clopidogrel
and 100 mg aspirin.
Results: A P2Y12 reaction unit (PRU)≥282 (AUC 0.719, 95% CI 0.588–0.851, p=0.004, sensitivity 68.8%, specificity
73.8%) was the optimal cut-off value in predicting 12-month MACE by receiver operating characteristic curve
analysis. Occurrence of MACE was significantly more frequent in patients with HPR (PRU≥282) compared to patients
without HPR (20.4% vs. 3.9%, HR 6.24, 95% CI 2.05–18.99, p=0.001). By multivariate analysis, HPR (HR
3.84, 95% CI 1.17–12.58, p=0.026) and elderly patients above 80 years of age (HR: 8.13, 95% CI 1.79–37.03,
p=0.007) were found to be the significant predictors of 12-month MACE. The MACE-free survival rate was significantly
lower in patients with HPR compared to patients without HPR (pb0.001).
Conclusion: HPR assessed by a point-of-care assay was able to predict 12-monthMACE in patients with STEMI who
underwent primary PCI with DES.
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