Key result
Routine VerifyNow testing after PCI did not significantly differ from standard care for 1-year net-MACE (adjusted HR 0.92; 95% CI 0.54-1.5; p=0.74).
Why the study?
High on-treatment ADP platelet reactivity measured by VerifyNow is a risk factor for ischemic events post-PCI, but whether its routine clinical use affects the choice of discharge P2Y12 antiplatelet therapy was unknown.
Does routine platelet reactivity testing with VerifyNow assay affect antiplatelet choice and reduce 1-year net-MACE in patients after percutaneous coronary intervention?
Cohort (n=1,001)
No
Does routine platelet reactivity testing with VerifyNow assay affect antiplatelet choice and reduce 1-year net-MACE in patients after percutaneous coronary intervention?
Hazard Ratio: 0.92 (95% CI 0.54–1.5)
p-value: p=0.74
Routine platelet reactivity testing after PCI was associated with a higher likelihood of discharge on clopidogrel but did not significantly improve 1-year net-MACE compared to standard care.
VN testing may influence P2Y12 inhibitor choice post-PCI; hypothesis-generating and requires prospective validation before practice change.
Background: High on-treatment ADP platelet reactivity (HPR) measured by VerifyNow P2Y12 assay (VN) is an established risk factor for ischemic events after percutaneous coronary intervention (PCI). We hypothesized that routine use of VN at time of PCI in clinical practice may affect choice of P2Y12 antiplatelet therapy at discharge. Methods: In a single center retrospective analysis, we examined the influence of VN testing on choice of P2Y12 inhibitor post PCI in routine clinical practice. Assessment of HPR was used routinely in clinical care during the time period of analysis at discretion of clinical providers. Subjects with PRU> 208 after the loading dose of clopidogrel or during clopidogrel steady state were switched to alternate P2Y12 inhibitors. Results: We identified 1001 patients with PCI during the time period specified. A total of 252 subjects underwent VN testing. Among those, 43% were found to have HPR on clopidogrel and were switched to alternate therapies (prasugrel [n=60], ticagrelor [n=48]). Patients who had VN platelet function testing were more likely to be discharged on clopidogrel as compared to those who did not have VN assay done (57% vs. 50%, p=0.039). There was no significant difference in 1-year net-MACE (CVD, MI, stent thrombosis, BARC 2 or higher bleeding) using tailored antiplatelet therapy (VN testing) as compared to standard of care group (adjusted HR:0.92, 95% CI: 0.54– 1.5, p=0.74). Conclusion: Routine use of VN assay in personalized antiplatelet treatment decision-making after PCI is associated with lower likelihood of using novel P2Y12 inhibitors.
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Mshelbwala et al. (2020) conducted a cohort in Percutaneous coronary intervention (n=1,001). VerifyNow platelet reactivity testing vs. Standard of care (no VerifyNow testing) was evaluated on 1-year net-MACE (CVD, MI, stent thrombosis, BARC 2 or higher bleeding) (adjusted HR 0.92, 95% CI 0.54-1.5, p=0.74). Routine VerifyNow testing after PCI did not significantly differ from standard care for 1-year net-MACE (adjusted HR 0.92; 95% CI 0.54-1.5; p=0.74).
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