This Article Figures Only Full Text Full Text (PDF) View Related Article in JACC Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Saw, J. Articles by Fung, A. Search for Related Content PubMed Articles by Saw, J. Articles by Fung, A. Related Collections Related Article

The Effects of Aspirin and Clopidogrel Response on Myonecrosis After Percutaneous Coronary Intervention

A BRIEF-PCI (Brief Infusion of Intravenous Eptifibatide Following Successful Percutaneous Coronary Intervention) Trial Substudy

Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada

^_* Reprint requests and correspondence: Dr. Jacqueline Saw, Division of Cardiology, Vancouver General Hospital, 2775 Laurel Street, 9th Floor, Vancouver, BC, V5Z 1M9, Canada (Email: jsaw{at}interchange.ubc.ca).

Objectives: The purpose of this study was to evaluate the effects of aspirin and clopidogrel response on myonecrosis after percutaneous coronary intervention (PCI) with glycoprotein (GP) IIb/IIIa blockade.

Background: Aspirin and clopidogrel resistance is increasingly recognized, but its effects on PCI outcomes with GP IIb/IIIa blockade are unknown.

Methods: This was a prospective, pre-specified substudy of the BRIEF-PCI (Brief Infusion of Intravenous Eptifibatide Following Successful Percutaneous Coronary Intervention) trial, which randomized 624 patients to 18-h or <2-h eptifibatide infusion after uncomplicated PCI. To be eligible, patients must have been pre-treated with aspirin (5 days) and clopidogrel (75 mg/day 5 days, 300 mg loading 6 h, or 600 mg loading 2 h) and must not have received GP IIb/IIIa inhibitors within 48 h. Verify-Now Aspirin and Clopidogrel (P2Y₁₂) assays were performed at baseline before PCI. Patients with aspirin reaction unit (ARU) 550 were labeled as aspirin resistant. Clopidogrel low-responders were defined as those in the lowest quartile of platelet inhibition. The primary end point was the prevalence of myonecrosis within 24 h after PCI.

Results: We enrolled 209 patients into our substudy, of which 185 had aspirin response assessed, 198 had clopidogrel response assessed, and 174 had both assessed. There were 4.9% who were aspirin resistant. Clopidogrel low-responders were defined as those in the lowest quartile with platelet inhibition <19%. Only 1.1% had both aspirin resistance and low clopidogrel response. There was no difference in myonecrosis prevalence among aspirin-resistant compared with aspirin-sensitive patients (11.1% vs. 27.8%, p = 0.259) or among clopidogrel low-responders compared with clopidogrel responders (23.5% vs. 29.3%, p = 0.433).

Conclusions: Aspirin and clopidogrel response did not affect myonecrosis prevalence amongst patients who received eptifibatide for PCI.

Key Words: aspirin • clopidogrel • PCI • resistance

Abbreviations and Acronyms   ARU = aspirin reaction unit   CK-MB = creatine kinase-myocardial band   GP = glycoprotein   PCI = percutaneous coronary intervention   TRAP = thrombin receptor activating protein   Tn-I = troponin-I

Related Article

Resisting the Temptation to Oversimplify Antiplatelet Resistance

Deepak L. Bhatt
J. Am. Coll. Cardiol. Intv. 2008 1: 660-662. [Full Text] [PDF]

This article has been cited by other articles:

				D. L. Bhatt Resisting the Temptation to Oversimplify Antiplatelet Resistance J. Am. Coll. Cardiol. Intv., December 1, 2008; 1(6): 660 - 662. [Full Text] [PDF]