Platelet activation predicts recurrent ischemic events after percutaneous coronary angioplasty: a 6 months prospective study

Thromb Res. 2006;118(4):487-93. doi: 10.1016/j.thromres.2005.10.011. Epub 2005 Dec 15.


Introduction: An increasing amount of evidence indicates that platelet reactivity, despite a standard anti-thrombotic therapy, is a potential risk factor for recurrent myocardial ischemia in patients with coronary artery disease. We now hypothesize that this condition, measured by collagen-epinephrine (CEPI) or collagen-ADP (CADP) closure times (CT) by Platelet Function Analyzer (PFA-100), may predict the recurrence of coronary events after percutaneous coronary intervention (PCI).

Materials and methods: CEPI and CADP-CT were measured 30+/-8 h after PCI in 175 consecutive patients admitted with a diagnosis of stable angina (n=94) or acute coronary syndromes (n=81) and prospectively followed up for a mean period of 6 months. We stratified the patients in accordance to both the CEPI-CT (<or> 190 s), reflecting the intensity of cycloxygenase inhibition by aspirin and the distribution into quartiles for CADP-CT.

Results: CEPI-CT<190 s as well as CADP-CT<82 s were associated with a higher rate of clinical recurrence (hazard ratio 8.5, p<0.001 and 22.9, p<0.001, respectively). Multivariate analysis after adjustment for other risk factors confirmed that the lowest CADP-CT quartile significantly correlates with the risk of recurrent coronary events (hazard ratio 36.5, p<0.01), as well as CEPI-CT<190 s (hazard ratio 6.7, p=0.01).

Conclusions: An enhanced platelet function after PCI when measured under high shear rates by PFA-100 is an independent predictor of a worst clinical outcome, even during a short term follow-up and may help in patients risk stratification.

MeSH terms

  • Adenosine Diphosphate / pharmacology
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Collagen / pharmacology
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / physiopathology
  • Coronary Artery Disease / therapy*
  • Epinephrine / pharmacology
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Myocardial Ischemia / diagnosis
  • Myocardial Ischemia / physiopathology
  • Myocardial Ischemia / therapy*
  • Platelet Activation* / drug effects
  • Platelet Aggregation / drug effects
  • Platelet Function Tests
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Survival Rate
  • Time Factors


  • Adenosine Diphosphate
  • Collagen
  • Epinephrine