Combination of P2Y12 reaction unit and percentage of platelet inhibition assessed by VerifyNow P2Y12 assay is a useful predictor of long-term clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Thromb Res. 2016 Mar:139:114-20. doi: 10.1016/j.thromres.2016.01.020. Epub 2016 Jan 27.

Abstract

Introduction: High on-treatment platelet reactivity is a well-known risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). This study was to investigate the value of a novel platelet reactivity-based system, named the COP-INH (COmbination of P2Y12 reaction unit [PRU] and percentage of platelet inhibition [%INH]), assessed by VerifyNow P2Y12 assay, for predicting the long-term ischaemic events in patients with acute coronary syndrome (ACS) undergoing PCI.

Materials and methods: The COP-INH was calculated on the basis of data obtained at 30days after PCI: patients with both an elevated PRU (≥230) and decreased %INH (<40%) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. The primary endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization at 1year follow-up. The relationship between the COP-INH score and primary endpoint was analyzed.

Results: 207 patients were enrolled. Baseline characteristics were similar between patients with COP-INH=2 and patients with COP-INH=1 or 0, except for diabetes mellitus (43.8% vs. 21.7%, p=0.015) and previous coronary artery bypass grafting (CABG) (21.9% vs. 6.86%, p=0.007). During the observation period, the incidence of major adverse cardiovascular events (MACE) in patients with COP-INH=2 was significantly higher than patients with COP-INH=1 or 0 (18.8% vs. 4.6%, p=0.007). Multivariate analysis of clinical characteristics and platelet reactivity selected by univariate analysis showed that the COP-INH=2 was an independent predictor of MACE in patients with ACS undergoing PCI (OR 2.745; 95% CI 1.369-9.851; p=0.024), whereas neither PRU≥230 nor %INH<40% was.

Conclusion: The COP-INH is considered to be a useful predictor of long-term ischaemic events of patients with ACS undergoing PCI.

Keywords: Acute coronary syndrome; Clopidogrel; Platelet reactivity; Stent.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / metabolism
  • Acute Coronary Syndrome / surgery*
  • Aged
  • Blood Platelets / drug effects*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control
  • Drug Monitoring / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Percutaneous Coronary Intervention / adverse effects*
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Platelet Function Tests / methods*
  • Point-of-Care Systems
  • Prospective Studies
  • Receptors, Purinergic P2Y12 / metabolism*
  • Risk Factors
  • Treatment Outcome

Substances

  • Platelet Aggregation Inhibitors
  • Receptors, Purinergic P2Y12