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J Am Coll Cardiol, 2006; 48:1742-1750, doi:10.1016/j.jacc.2006.06.065
(Published online 16 October 2006). © 2006 by the American College of Cardiology Foundation |
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* Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
Institut für Medizinische Biometrie und Medizinische Informatik, University of Freiburg, Freiburg, Germany.
Manuscript received December 8, 2005; revised manuscript received May 30, 2006, accepted June 6, 2006.
* Reprint requests and correspondence: Dr. Franz-Josef Neumann, Herz-Zentrum Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany. (Email: franz-josef.neumann{at}herzzentrum.de).
OBJECTIVES: Our prospective study tested the hypothesis that the 30-day clinical outcome of elective percutaneous catheter intervention (PCI) differs between strata defined by quartiles of platelet aggregation after loading with 600 mg clopidogrel.
BACKGROUND: Platelet responses after loading with clopidogrel are highly variable. The impact of this variability on the peri-interventional risk of patients undergoing PCI has not been investigated prospectively.
METHODS: Our study included 802 consecutive patients undergoing elective coronary stent placement. Before PCI, patients received a loading dose of 600 mg clopidogrel followed by 75 mg daily. Primary end point was the 30-day composite of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events [MACE]). Platelet aggregation was assessed immediately before PCI by optical aggregometry (5 µmol/l adenosine diphosphate).
RESULTS: During 30-day follow-up, 15 patients (1.9%) incurred MACE (3 deaths, 8 myocardial infarctions, 8 target lesion revascularizations). Quartiles of platelet aggregation were <4%, 4% to 14%, 15% to 32%, and >32%. Thirty-day MACE differed significantly (p = 0.034) between quartiles of platelet aggregation. It was 0.5% in the first quartile, 0.5% in the second, 3.1% in the third, and 3.5% in the fourth. Platelet aggregation above the median carried a 6.7-fold risk (95% confidence interval 1.52 to 29.41; p = 0.003) of 30-day MACE. Multivariable logistic regression analysis, including pertinent covariables, confirmed platelet aggregation as a significant independent predictor of 30-day MACE (adjusted odds ratio per 10% increase in platelet aggregation 1.32, 95% confidence interval 1.04 to 1.61; p = 0.026).
CONCLUSIONS: The level of platelet aggregation immediately before elective coronary stenting in patients pre-treated with a high loading dose of clopidogrel is correlated with early outcome after the procedure.
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