Author + information
- Received July 8, 2009
- Revision received September 9, 2009
- Accepted October 5, 2009
- Published online January 1, 2010.
- Fabio Mangiacapra, MD⁎,†,
- Bernard De Bruyne, MD, PhD⁎,
- Olivier Muller, MD, PhD⁎,
- Catalina Trana, MD⁎,
- Argyrios Ntalianis, MD, PhD⁎,
- Jozef Bartunek, MD, PhD⁎,
- Guy Heyndrickx, MD, PhD⁎,
- Germano Di Sciascio, MD†,
- William Wijns, MD, PhD⁎ and
- Emanuele Barbato, MD, PhD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Emanuele Barbato, Cardiovascular Center OLV, Moorselbaan 164, B-9300 Aalst, Belgium
Objectives We tested the hypothesis that residual platelet reactivity after clopidogrel correlates with the extent and severity of coronary atherosclerosis in patients undergoing elective percutaneous coronary intervention (PCI).
Background Platelets are actively involved in vascular atherosclerosis.
Methods We prospectively enrolled 338 patients undergoing PCI for stable angina, loaded with 600-mg clopidogrel. Platelet reactivity was assessed 12 h later by measuring P2Y12 reactivity unit (PRU) with VerifyNow P2Y12 assay (Accumetrics, San Diego, California). High platelet reactivity (HPR) was defined as PRU value ≥240. Presence of multivessel disease (MVD) and total stent length (TSL) were used as surrogate markers of atherosclerosis severity and extension.
Results Patients with MVD showed higher PRU compared with single-vessel disease (SVD) patients (222 ± 85 vs. 191 ± 73; p < 0.001). The PRU increased with the number of stenotic coronaries (1-vessel disease: 191 ± 73; 2-vessel disease: 220 ± 88; 3-vessel disease: 226 ± 80; p = 0.002). The PRU was higher in the third TSL tertile compared with first tertile (217 ± 83 vs. 191 ± 73; p = 0.048). The HPR was most frequently observed among MVD patients (40.5% vs. 21.6% in patients with SVD, respectively; p < 0.001) and those in the third TSL tertile (35.8% vs. 22.2% first tertile; p = 0.028). Higher incidence of periprocedural myocardial infarction was observed in patients with HPR (41.2% vs. 26.7% in patients without HPR; p = 0.008) and in those in the third tertile TSL (37.7% vs. 23.1% first tertile; p = 0.020). By multivariate analysis, HPR was the only independent predictor of periprocedural myocardial infarction (p = 0.034).
Conclusions Patients with more extensive coronary atherosclerosis have a higher rate of HPR, which might partly account for higher risk of periprocedural MI.
- Received July 8, 2009.
- Revision received September 9, 2009.
- Accepted October 5, 2009.
- American College of Cardiology Foundation