Impact of P2Y12 Inhibition by Clopidogrel on Cardiovascular Mortality in Unselected Patients Treated by Percutaneous Coronary Angioplasty
| Autor: | Pierre Bareiss, Bogdan Radulescu, Soraya El Ghannudi, Nicolas Meyer, Olivier Morel, Michel Chauvin, Patrick Ohlmann, Marie-Louise Wiesel, Christian Gachet |
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| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
education.field_of_study Acute coronary syndrome business.industry medicine.medical_treatment Population Percutaneous coronary intervention medicine.disease Clopidogrel P2Y12 Internal medicine Angioplasty Conventional PCI medicine Cardiology cardiovascular diseases Platelet activation Cardiology and Cardiovascular Medicine education business medicine.drug |
| Zdroj: | JACC: Cardiovascular Interventions. 3:648-656 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2010.03.003 |
| Popis: | Objectives The aim of this study was to determine whether low platelet response to the P2Y12 receptor antagonist clopidogrel as assessed by Vasodilator-stimulated phosphoprotein flow cytometry test (VASP- FCT) predicts cardiovascular events in a high-risk population undergoing percutaneous coronary intervention (PCI). Background Impaired platelet responsiveness to clopidogrel is thought to be a determinant of cardiovascular events after PCI. The platelet VASP-FCT is a new assay specific to the P2Y12 adenosine diphosphate receptor-pathway. In this test, platelet activation is expressed as platelet reactivity index (PRI). Methods Four-hundred sixty-one unselected patients undergoing urgent (n = 346) or planned (n = 115) PCI were prospectively enrolled. Patients were classified as low-response (LR) and response (R) to clopidogrel, depending on their PRI. Optimal PRI cutoff was determined by receiver-operator characteristic curve analysis to 61% (LR: PRI ≥61% and R: PRI Results At follow-up, total cardiac mortality rates and possible and total stent thrombosis were higher in LR patients. Multivariate analysis identified creatinine clearance (hazard ratio [HR]: 0.95; 95% confidence interval [CI]: 0.93 to 0.98, p Conclusions In patients undergoing PCI, LR to clopidogrel assessed by VASP-FCT is an independent predictor of cardiovascular death at the PRI cutoff value of ≥61%. The LR clinical impact seems to be dependent on the type of stent implanted. |
| Databáze: | OpenAIRE |
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