Objectives: We sought to evaluate the influence of platelet reactivity after clopidogrel, as assessed by the VerifyNow point-of-care assay (Accumetrics, San Diego, California), on myonecrosis in low-to-intermediate risk patients undergoing percutaneous coronary intervention (PCI). Background: Inadequate platelet inhibition at the time of PCI is associated with a higher risk of recurrent ischemic events. Methods: A total of 250 consecutive biomarker-negative patients treated with clopidogrel and undergoing elective PCI were enrolled. Cardiac biomarkers (creatine kinase-myocardial band and troponin I) were measured before and 8 and 24 h after intervention. Platelet reactivity after clopidogrel was assessed immediately before PCI by the VerifyNow P2Y12 point-of-care assay. High platelet reactivity (HPR) after clopidogrel was defined as a platelet reaction unit value ≥240. Results: Patients with HPR (31% of the overall population) showed more frequent myonecrosis, with statistical significance with regard to creatine kinase-myocardial band elevation (35% vs. 20%; p = 0.011), and by trend with regard to troponin-I elevation (47% vs. 35%; p = 0.059). Incidence of periprocedural myocardial infarction was higher in patients with HPR, both by creatine kinase-myocardial band (13% vs. 4%; p = 0.011) and troponin-I definition (32% vs. 19%; p = 0.019). By multivariable analysis, HPR was an independent predictor of periprocedural myocardial infarction. Conclusions: Easily assessed by a point-of-care assay, HPR after clopidogrel is a frequent finding and is associated with increased risk of myonecrosis in low-to-intermediate risk patients undergoing planned PCI. © 2010 American College of Cardiology Foundation.

Point-of-Care Assessment of Platelet Reactivity After Clopidogrel to Predict Myonecrosis in Patients Undergoing Percutaneous Coronary Intervention / Mangiacapra, F.; Barbato, Emanuele; Patti, G.; Gatto, L.; Vizzi, V.; Ricottini, E.; D'Ambrosio, A.; Wijns, W.; Di Sciascio, G.. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 3:3(2010), pp. 318-323. [10.1016/j.jcin.2009.12.012]

Point-of-Care Assessment of Platelet Reactivity After Clopidogrel to Predict Myonecrosis in Patients Undergoing Percutaneous Coronary Intervention

BARBATO, EMANUELE;
2010

Abstract

Objectives: We sought to evaluate the influence of platelet reactivity after clopidogrel, as assessed by the VerifyNow point-of-care assay (Accumetrics, San Diego, California), on myonecrosis in low-to-intermediate risk patients undergoing percutaneous coronary intervention (PCI). Background: Inadequate platelet inhibition at the time of PCI is associated with a higher risk of recurrent ischemic events. Methods: A total of 250 consecutive biomarker-negative patients treated with clopidogrel and undergoing elective PCI were enrolled. Cardiac biomarkers (creatine kinase-myocardial band and troponin I) were measured before and 8 and 24 h after intervention. Platelet reactivity after clopidogrel was assessed immediately before PCI by the VerifyNow P2Y12 point-of-care assay. High platelet reactivity (HPR) after clopidogrel was defined as a platelet reaction unit value ≥240. Results: Patients with HPR (31% of the overall population) showed more frequent myonecrosis, with statistical significance with regard to creatine kinase-myocardial band elevation (35% vs. 20%; p = 0.011), and by trend with regard to troponin-I elevation (47% vs. 35%; p = 0.059). Incidence of periprocedural myocardial infarction was higher in patients with HPR, both by creatine kinase-myocardial band (13% vs. 4%; p = 0.011) and troponin-I definition (32% vs. 19%; p = 0.019). By multivariable analysis, HPR was an independent predictor of periprocedural myocardial infarction. Conclusions: Easily assessed by a point-of-care assay, HPR after clopidogrel is a frequent finding and is associated with increased risk of myonecrosis in low-to-intermediate risk patients undergoing planned PCI. © 2010 American College of Cardiology Foundation.
2010
clopidogrel; creatine kinase; troponin I; aged; article; bioassay; cardiovascular risk; controlled study; female; heart infarction; human; loading drug dose; major clinical study; male; muscle necrosis; percutaneous coronary intervention; point of care testing; priority journal; risk assessment; risk factor; thrombocyte aggregation inhibition; Aged; Angioplasty; Transluminal; Percutaneous Coronary; Biological Markers; Blood Platelets; Coronary Artery Disease; Creatine Kinase; MB Form; Female; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction; Myocardium; Necrosis; Odds Ratio; Platelet Aggregation Inhibitors; Platelet Function Tests; Point-of-Care Systems; Predictive Value of Tests; Receptors; Purinergic P2; Risk Assessment; Risk Factors; Ticlopidine; Time Factors; Treatment Outcome; Troponin I; high platelet reactivity; myocardial infarction; percutaneous coronary intervention; point-of-care platelet function test
01 Pubblicazione su rivista::01a Articolo in rivista
Point-of-Care Assessment of Platelet Reactivity After Clopidogrel to Predict Myonecrosis in Patients Undergoing Percutaneous Coronary Intervention / Mangiacapra, F.; Barbato, Emanuele; Patti, G.; Gatto, L.; Vizzi, V.; Ricottini, E.; D'Ambrosio, A.; Wijns, W.; Di Sciascio, G.. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 3:3(2010), pp. 318-323. [10.1016/j.jcin.2009.12.012]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1660371
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