Author + information
- Sang Yeub Lee,
- Ju-Hee Lee,
- Sang Min Kim,
- Jang-Whan Bae,
- Kyung-Kuk Hwang,
- Dong-Woon Kim and
- Myeong-Chan Cho
Platelets are closely associated with vascular occlusive event.
We evaluated platelet reactivity measured by the VerifyNow P2Y12 assay and clinical outcomes in patients with coronary artery disease treated with clopidogrel and percutaneous coronary intervention of real world practice. We recruited clopidogrel-treated patients undergoing emergent or elective PCI for stable angina or acute coronary syndrome (non-ST-elevation and ST-elevation myocardial infarction, unstable angina). The main outcome measures were cardiovascular (CV) death, definite/probable stent thrombosis (ST), nonfatal myocardial infarction (MI), coronary revascularization (PCI or CABG) and a composite end point of ischemic events. High platelet reactivity (HPR) was defined as PRU (P2Y12 Reaction Unit) value ≥ 240 or 252.
In total, 1038 consecutive patients were enrolled (Male 749, 72.7%). Patients with HPR were 487 (46.9%). VerifyNow P2Y12 cartridge was used in 1038 patients. All patients received optimal clopidogrel pretreatment and maintenance therapy. At a 12-month follow-up, we found 85 ischemic events (18 CV deaths [1.7%], 7 nonfatal MIs [0.7%]), 5 stent thrombosis (0.5%) and 47 target-vessel revascularizations (4.5%). The CV rate of patients with HPR (PRU > 240) was significantly higher rate (2.7% vs 1.0% (p = 0.030)) than the patients with normal value. The composite end point event rate of patients with HPR (PRU > 240) was also significantly higher rate (8.07% vs 4.5% (p = 0.020)) than the patients with normal value. In survival analysis, there was no significant difference between patient with HPR (PRU > 240) and normal reactivity. But between patient with HPR (PRU > 252, cutoff value of CILON-T trial) and normal reactivity, the survival rate free from the CV death was significantly lower in patients with high on-treatment platelet reactivity(p = 0.037, Log Rank test).
HPR tested by VerifyNow predict coronary adverse event in patients after PCI. In Korean, the rate of HPR was higher than western people and we seem to have to raise the optimal cutoff value of PRU to predict future coronary event in Korean.