Key result
High posttreatment platelet reactivity to a 600 mg clopidogrel loading dose was associated with higher rates of cardiac death, unstable angina, and rehospitalization (19.6% vs 6.8%, P=0.029).
Why the study?
The impact of high posttreatment platelet reactivity to a 600 mg loading dose of clopidogrel on outcomes in Chinese patients with ACS undergoing PCI was unknown.
Does high posttreatment platelet reactivity to a 600 mg loading dose of clopidogrel increase the risk of adverse cardiac events in Chinese patients with ACS undergoing PCI?
Observational (n=134)
Does high posttreatment platelet reactivity to a 600 mg loading dose of clopidogrel increase the risk of adverse cardiac events in Chinese patients with ACS undergoing PCI?
Absolute Event Rate: 19.6% vs 6.8%
p-value: p=0.029
In Chinese patients with ACS undergoing PCI, high posttreatment platelet reactivity to a 600 mg clopidogrel loading dose is associated with a significantly higher risk of adverse cardiac events at 6 months.
Supports platelet reactivity testing as a risk marker in Chinese ACS patients post-PCI; leaves open whether it should guide clopidogrel therapy.
Objectives: We sought to determine whether high posttreatment platelet reactivity (HPPR) to a 600 mg loading dose of clopidogrel affects outcomes in Chinese patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI) and to investigate whether there is a relationship between the number of platelet reactivity units (PRUs) and the characteristics of the patients. Background: Although impaired platelet response to clopidogrel is a strong predictor of unfavorable outcome after PCI, the impact of HPPR to a 600 mg loading dose of clopidogrel in Chinese patients with ACS undergoing PCI is still unknown. Methods: We performed observational research on 134 unselected patients with ACS undergoing urgent or planned PCI with a 600 mg loading dose of clopidogrel. Platelet activation was expressed as the PRU value measured by the VerifyNow assay. Results: Among the 134 patients (mean age 60.62 years [standard deviation 9.13 years], 60.4% male), there were 46 patients with HPPR (34.3%) and 88 patients without HPPR (65.7%). At a mean follow-up of 6 months (standard deviation 1 month), the rates of cardiac death, unstable angina, and rehospitalization for target lesion revascularization were higher in the HPPR group (19.6% vs. 6.8%, P=0.029). Multivariate analysis identified hemoglobin level and sex as independent predictors of the PRU value ( y =456.355−1.736 x 1 −31.880 x 2 , P<0.05). On receiver operating characteristic curve analysis, PRU values could significantly discriminate between patients with and patients without cardiac death, unstable angina, and rehospitalization for target lesion revascularization (area under the curve 0.758, 95% confidence interval 0.62–0.85, P=0.001, P<0.05). Conclusion: In patients with ACS, HPPR to a 600 mg loading dose of clopidogrel is associated with worse outcomes after PCI. There is some relationship between the PRU value and the hemoglobin level and sex. PRU values can predict the prognosis.
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Li et al. (2020) conducted an observational in Acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) (n=134). High posttreatment platelet reactivity (HPPR) vs. No high posttreatment platelet reactivity was evaluated on Cardiac death, unstable angina, and rehospitalization for target lesion revascularization (p=0.029). High posttreatment platelet reactivity to a 600 mg clopidogrel loading dose was associated with higher rates of cardiac death, unstable angina, and rehospitalization (19.6% vs 6.8%, P=0.029).
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