Point-of-care assessment of platelet reactivity after clopidogrel to predict myonecrosis in patients undergoing percutaneous coronary intervention

JACC Cardiovasc Interv. 2010 Mar;3(3):318-23. doi: 10.1016/j.jcin.2009.12.012.


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 > or =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.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Biomarkers / blood
  • Blood Platelets / drug effects*
  • Blood Platelets / metabolism
  • Clopidogrel
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / therapy*
  • Creatine Kinase, MB Form / blood
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / etiology*
  • Myocardial Infarction / pathology
  • Myocardial Infarction / prevention & control
  • Myocardium / pathology*
  • Necrosis
  • Odds Ratio
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Platelet Function Tests*
  • Point-of-Care Systems*
  • Predictive Value of Tests
  • Purinergic P2 Receptor Antagonists
  • Receptors, Purinergic P2 / blood
  • Receptors, Purinergic P2Y12
  • Risk Assessment
  • Risk Factors
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use
  • Time Factors
  • Treatment Outcome
  • Troponin I / blood


  • Biomarkers
  • P2RY12 protein, human
  • Platelet Aggregation Inhibitors
  • Purinergic P2 Receptor Antagonists
  • Receptors, Purinergic P2
  • Receptors, Purinergic P2Y12
  • Troponin I
  • Clopidogrel
  • Creatine Kinase, MB Form
  • Ticlopidine