Advertisement

Click here for more guidelines.

 
 




CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2008; 52:1128-1133, doi:10.1016/j.jacc.2008.06.038
© 2008 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View Related Journal Scan on Cardiosource
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (35)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Patti, G.
Right arrow Articles by Di Sciascio, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Patti, G.
Right arrow Articles by Di Sciascio, G.
Related Collections
Right arrowRelated Article

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Point-of-Care Measurement of Clopidogrel Responsiveness Predicts Clinical Outcome in Patients Undergoing Percutaneous Coronary Intervention

Results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity Predicts Outcome) Study

Giuseppe Patti, MD, FACC, Annunziata Nusca, MD, Fabio Mangiacapra, MD, Laura Gatto, MD, Andrea D'Ambrosio, MD and Germano Di Sciascio, MD, FACC*

Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy

Manuscript received March 25, 2008; revised manuscript received June 5, 2008, accepted June 9, 2008.

* Reprint requests and correspondence: Prof. Germano Di Sciascio, Department of Cardiovascular Sciences, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Rome, Italy (Email: g.disciascio{at}unicampus.it).

Objectives: The aim of this study was to evaluate the correlation of point-of-care measurement of platelet inhibition with clinical outcome in patients undergoing percutaneous coronary intervention (PCI).

Background: Individual variability of clopidogrel response might influence results of PCI.

Methods: A total of 160 patients receiving clopidogrel before PCI were prospectively enrolled. Platelet reactivity was measured by the VerifyNow P2Y12 assay (Accumetrics Inc., San Diego, California). Primary end point was 30-day occurrence of major adverse cardiac events (MACE) according to quartile distribution of P2Y12 reaction units (PRU).

Results: Primary end point occurred more frequently in patients with pre-procedural PRU levels in the fourth quartile versus those in the lowest quartile (20% vs. 3%; p = 0.034), and it was entirely due to periprocedural myocardial infarction (MI). Mean PRU absolute levels were higher in patients with periprocedural MI (258 ± 53 vs. 219 ± 69 in patients without; p = 0.030). On multivariable analysis pre-PCI PRU levels in the fourth quartile were associated with 6-fold increased risk of 30-day MACE (odds ratio: 6.1; 95% confidence interval: 1.1 to 18.3, p = 0.033). By receiver-operating characteristic curve analysis, the optimal cut-off for the primary end point was a pre-PCI PRU value ≥240 (area under the curve: 0.69; 95% confidence interval: 0.56 to 0.81, p = 0.016).

Conclusions: This study indicates that high pre-PCI platelet reactivity might predict 30-day events. Use of a rapid point-of-care assay for monitoring residual platelet reactivity after clopidogrel administration might help identify patients in whom individualized antiplatelet strategies might be indicated with coronary intervention.

Key Words: clopidogrel • percutaneous coronary intervention • platelet aggregometry

Abbreviations and Acronyms
  ACS = acute coronary syndromes
  ADP = adenosine diphosphate
  CK-MB = creatine kinase-myocardial band
  LTA = light transmittance aggregometry
  MACE = major adverse cardiac events
  MI = myocardial infarction
  PCI = percutaneous coronary intervention
  PRU = platelet (P2Y12) reaction units
  ROC = receiver-operating characteristic
  Tn = troponin


Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A31-A32. [Full Text] [PDF]



This article has been cited by other articles:


Home page
J Am Coll CardiolHome page
D.-W. Park, S.-W. Lee, S.-C. Yun, H.-G. Song, J.-M. Ahn, J.-Y. Lee, W.-J. Kim, S.-J. Kang, Y.-H. Kim, C. W. Lee, et al.
A Point-of-Care Platelet Function Assay and C-Reactive Protein for Prediction of Major Cardiovascular Events After Drug-Eluting Stent Implantation.
J. Am. Coll. Cardiol., December 13, 2011; 58(25): 2630 - 2639.
[Abstract] [Full Text] [PDF]


Home page
Clin. Chem.Home page
J. Zhu, N. Zou, D. Zhu, J. Wang, Q. Jin, J. Zhao, and H. Mao
Simultaneous Detection of High-Sensitivity Cardiac Troponin I and Myoglobin by Modified Sandwich Lateral Flow Immunoassay: Proof of Principle
Clin. Chem., December 1, 2011; 57(12): 1732 - 1738.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
S. Y. Shaw and A. D. Brettman
Phenotyping Patient-Derived Cells for Translational Studies in Cardiovascular Disease
Circulation, November 29, 2011; 124(22): 2444 - 2455.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. S. Brar, J. ten Berg, R. Marcucci, M. J. Price, M. Valgimigli, H.-S. Kim, G. Patti, N. J. Breet, G. DiSciascio, T. Cuisset, et al.
Impact of Platelet Reactivity on Clinical Outcomes After Percutaneous Coronary Intervention: A Collaborative Meta-Analysis of Individual Participant Data
J. Am. Coll. Cardiol., November 1, 2011; 58(19): 1945 - 1954.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
G. Patti, G. Barczi, D. Orlic, F. Mangiacapra, G. Colonna, V. Pasceri, E. Barbato, B. Merkely, I. Edes, M. Ostojic, et al.
Outcome Comparison of 600- and 300-mg Loading Doses of Clopidogrel in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: Results From the ARMYDA-6 MI (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Myocardial Infarction) Randomized Study
J. Am. Coll. Cardiol., October 4, 2011; 58(15): 1592 - 1599.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
M. J. Price, D. J. Angiolillo, P. S. Teirstein, E. Lillie, S. V. Manoukian, P. B. Berger, J.-F. Tanguay, C. P. Cannon, and E. J. Topol
Platelet Reactivity and Cardiovascular Outcomes After Percutaneous Coronary Intervention: A Time-Dependent Analysis of the Gauging Responsiveness With a VerifyNow P2Y12 Assay: Impact on Thrombosis and Safety (GRAVITAS) Trial
Circulation, September 6, 2011; 124(10): 1132 - 1137.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
D. J. Angiolillo, E. Bernardo, M. Zanoni, D. Vivas, P. Capranzano, G. Malerba, D. Capodanno, P. Prandini, A. Pasquali, E. Trabetti, et al.
Impact of Insulin Receptor Substrate-1 Genotypes on Platelet Reactivity and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus and Coronary Artery Disease
J. Am. Coll. Cardiol., June 28, 2011; 58(1): 30 - 39.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
G. Campo, G. Parrinello, P. Ferraresi, B. Lunghi, M. Tebaldi, M. Miccoli, J. Marchesini, F. Bernardi, R. Ferrari, and M. Valgimigli
Prospective Evaluation of On-Clopidogrel Platelet Reactivity Over Time in Patients Treated With Percutaneous Coronary Intervention: Relationship With Gene Polymorphisms and Clinical Outcome
J. Am. Coll. Cardiol., June 21, 2011; 57(25): 2474 - 2483.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol IntvHome page
D. Alexopoulos, G. Dimitropoulos, P. Davlouros, I. Xanthopoulou, G. Kassimis, E. F. Stavrou, G. Hahalis, and A. Athanassiadou
Prasugrel Overcomes High On-Clopidogrel Platelet Reactivity Post-Stenting More Effectively Than High-Dose (150-mg) Clopidogrel: The Importance of CYP2C19*2 Genotyping
J. Am. Coll. Cardiol. Intv., April 1, 2011; 4(4): 403 - 410.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
G. Patti, D. Grieco, G. Dicuonzo, V. Pasceri, A. Nusca, and G. Di Sciascio
High Versus Standard Clopidogrel Maintenance Dose After Percutaneous Coronary Intervention and Effects on Platelet Inhibition, Endothelial Function, and Inflammation: Results of the ARMYDA-150 mg (Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty) Randomized Study
J. Am. Coll. Cardiol., February 15, 2011; 57(7): 771 - 778.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J.-W. Suh, S.-P. Lee, K.-W. Park, H.-Y. Lee, H.-J. Kang, B.-K. Koo, Y.-S. Cho, T.-J. Youn, I.-H. Chae, D.-J. Choi, et al.
Multicenter Randomized Trial Evaluating the Efficacy of Cilostazol on Ischemic Vascular Complications After Drug-Eluting Stent Implantation for Coronary Heart Disease: Results of the CILON-T (Influence of CILostazol-based triple antiplatelet therapy ON ischemic complication after drug-eluting stenT implantation) Trial
J. Am. Coll. Cardiol., January 18, 2011; 57(3): 280 - 289.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
Y.-L. Kwak, J.-C. Kim, Y.-S. Choi, K.-J. Yoo, Y. Song, and J.-K. Shim
Clopidogrel Responsiveness Regardless of the Discontinuation Date Predicts Increased Blood Loss and Transfusion Requirement After Off-Pump Coronary Artery Bypass Graft Surgery
J. Am. Coll. Cardiol., December 7, 2010; 56(24): 1994 - 2002.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
G. Campo, L. Fileti, N. de Cesare, E. Meliga, A. Furgieri, F. Russo, S. Colangelo, S. Brugaletta, R. Ferrari, M. Valgimigli, et al.
Long-Term Clinical Outcome Based on Aspirin and Clopidogrel Responsiveness Status After Elective Percutaneous Coronary Intervention: A 3T/2R (Tailoring Treatment With Tirofiban in Patients Showing Resistance to Aspirin and/or Resistance to Clopidogrel) Trial Substudy
J. Am. Coll. Cardiol., October 26, 2010; 56(18): 1447 - 1455.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll Cardiol IntvHome page
C. M. Barker, S. S. Murray, P. S. Teirstein, D. E. Kandzari, E. J. Topol, and M. J. Price
Pilot Study of the Antiplatelet Effect of Increased Clopidogrel Maintenance Dosing and Its Relationship to CYP2C19 Genotype in Patients With High On-Treatment Reactivity
J. Am. Coll. Cardiol. Intv., October 1, 2010; 3(10): 1001 - 1007.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
L. Bonello, U. S. Tantry, R. Marcucci, R. Blindt, D. J. Angiolillo, R. Becker, D. L. Bhatt, M. Cattaneo, J. P. Collet, T. Cuisset, et al.
Consensus and Future Directions on the Definition of High On-Treatment Platelet Reactivity to Adenosine Diphosphate
J. Am. Coll. Cardiol., September 14, 2010; 56(12): 919 - 933.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. Garg and P. W. Serruys
Coronary Stents: Current Status
J. Am. Coll. Cardiol., August 31, 2010; 56(10_Suppl_S): S1 - S42.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
G. Di Sciascio, G. Patti, V. Pasceri, L. Gatto, G. Colonna, A. Montinaro, and on behalf of the ARMYDA-5 PRELOAD Investigators
Effectiveness of In-Laboratory High-Dose Clopidogrel Loading Versus Routine Pre-Load in Patients Undergoing Percutaneous Coronary Intervention: Results of the ARMYDA-5 PRELOAD (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) Randomized Trial
J. Am. Coll. Cardiol., August 10, 2010; 56(7): 550 - 557.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Neuroradiol.Home page
H.- S. Kang, B. J. Kwon, J. E. Kim, and M. H. Han
Preinterventional Clopidogrel Response Variability for Coil Embolization of Intracranial Aneurysms: Clinical Implications
AJNR Am. J. Neuroradiol., August 1, 2010; 31(7): 1206 - 1210.
[Abstract] [Full Text] [PDF]


Home page
Circ Cardiovasc IntervHome page
M. J. Price, A. Kalyanasundaram, and P. B. Berger
The Evidence Base for Platelet Function Testing in Patients Undergoing Percutaneous Coronary Intervention
Circ Cardiovasc Interv, June 1, 2010; 3(3): 277 - 283.
[Full Text] [PDF]


Home page
Eur Heart JHome page
G. Di Sciascio, G. Patti, V. Pasceri, G. Colonna, F. Mangiacapra, A. Montinaro, and on behalf of the ARMYDA-4 RELOAD Investigators
Clopidogrel reloading in patients undergoing percutaneous coronary intervention on chronic clopidogrel therapy: results of the ARMYDA-4 RELOAD (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) randomized trial
Eur. Heart J., June 1, 2010; 31(11): 1337 - 1343.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J. A. Barrabes and L. Galian
Endogenous Thrombolysis: A Hidden Player in Acute Coronary Syndromes?
J. Am. Coll. Cardiol., May 11, 2010; 55(19): 2116 - 2117.
[Full Text] [PDF]


Home page
J Am Coll Cardiol IntvHome page
F. Mangiacapra, E. Barbato, G. Patti, L. Gatto, V. Vizzi, E. Ricottini, A. D'Ambrosio, W. Wijns, and G. Di Sciascio
Point-of-Care Assessment of Platelet Reactivity After Clopidogrel to Predict Myonecrosis in Patients Undergoing Percutaneous Coronary Intervention
J. Am. Coll. Cardiol. Intv., March 1, 2010; 3(3): 318 - 323.
[Abstract] [Full Text] [PDF]


Home page
JAMAHome page
N. J. Breet, J. W. van Werkum, H. J. Bouman, J. C. Kelder, H. J. T. Ruven, E. T. Bal, V. H. Deneer, A. M. Harmsze, J. A. S. van der Heyden, B. J. W. M. Rensing, et al.
Comparison of Platelet Function Tests in Predicting Clinical Outcome in Patients Undergoing Coronary Stent Implantation
JAMA, February 24, 2010; 303(8): 754 - 762.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
G. Campo, M. Valgimigli, A. Frangione, S. Luccarelli, E. Cangiano, C. Cavazza, L. Fileti, R. Ferrari, and On behalf of the 3T/2R Investigators
Evaluation of Platelet Inhibition by Tirofiban in Patients Stratified According to Aspirin and Clopidogrel Responsiveness: The 3T/2R (Tailoring Treatment with Tirofiban in patients showing Resistance to aspirin and/or Resistance to clopidogrel)
J. Am. Coll. Cardiol., January 19, 2010; 55(3): 255 - 256.
[Full Text] [PDF]


Home page
J Am Coll Cardiol IntvHome page
F. Mangiacapra, B. De Bruyne, O. Muller, C. Trana, A. Ntalianis, J. Bartunek, G. Heyndrickx, G. Di Sciascio, W. Wijns, and E. Barbato
High Residual Platelet Reactivity After Clopidogrel: Extent of Coronary Atherosclerosis and Periprocedural Myocardial Infarction in Patients With Stable Angina Undergoing Percutaneous Coronary Intervention
J. Am. Coll. Cardiol. Intv., January 1, 2010; 3(1): 35 - 40.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
A. de Miguel Castro, A. Diego Nieto, and A. Perez de Prado
Letter by de Miguel Castro et al Regarding Article, "Cardiovascular Death and Nonfatal Myocardial Infarction in Acute Coronary Syndrome Patients Receiving Coronary Stenting Are Predicted by Residual Platelet Reactivity to ADP Detected by a Point-of-Care Assay: A 12-Month Follow-Up"
Circulation, September 29, 2009; 120(13): e98 - e98.
[Full Text] [PDF]


Home page
Eur Heart JHome page
C. Verstuyft, T. Simon, and R. B. Kim
Personalized medicine and antiplatelet therapy: ready for prime time?
Eur. Heart J., August 2, 2009; 30(16): 1943 - 1963.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol., June 2, 2009; 53(22): 2080 - 2097.
[Full Text] [PDF]


Home page
CirculationHome page
M. J. Price
Bedside Evaluation of Thienopyridine Antiplatelet Therapy
Circulation, May 19, 2009; 119(19): 2625 - 2632.
[Full Text] [PDF]


Home page
Cleveland Clinic Journal of MedicineHome page
D. L. BHATT, K. KOTTKE-MARCHANT, J. H. ALEXANDER, W. F. PEACOCK, and M. S. SABATINE
Platelet response in practice: Applying new insights and tools for testing and treatment
Cleveland Clinic Journal of Medicine, April 1, 2009; 76(Suppl_1): S24 - S32.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
D. Sibbing, S. Braun, T. Morath, J. Mehilli, W. Vogt, A. Schomig, A. Kastrati, and N. von Beckerath
Platelet Reactivity After Clopidogrel Treatment Assessed With Point-of-Care Analysis and Early Drug-Eluting Stent Thrombosis
J. Am. Coll. Cardiol., March 10, 2009; 53(10): 849 - 856.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al.
Highlights of the Year in JACC 2008
J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398.
[Full Text] [PDF]


Home page
CirculationHome page
R. Marcucci, A. M. Gori, R. Paniccia, B. Giusti, S. Valente, C. Giglioli, P. Buonamici, D. Antoniucci, R. Abbate, and G. F. Gensini
Cardiovascular Death and Nonfatal Myocardial Infarction in Acute Coronary Syndrome Patients Receiving Coronary Stenting Are Predicted by Residual Platelet Reactivity to ADP Detected by a Point-of-Care Assay: A 12-Month Follow-Up
Circulation, January 20, 2009; 119(2): 237 - 242.
[Abstract] [Full Text] [PDF]



 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement