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Value of Platelet Reactivity in Predicting Response to Treatment and Clinical Outcome in Patients Undergoing Primary Coronary Intervention

Insights Into the STRATEGY Study

Gianluca Campo, MD^_*, Marco Valgimigli, MD, PhD^_*,,,_*, Donato Gemmati, MS, Gianfranco Percoco, MD^_*, Silvia Tognazzo, MS, Giordano Cicchitelli, MD^_*, Linda Catozzi, MS, Patrizia Malagutti, MD^_*, Maurizio Anselmi, MD^||, Corrado Vassanelli, MD^||, Gianluigi Scapoli, MD and Roberto Ferrari, MD, PhD^_*,

^_* Department of Cardiology, University of Ferrara, Ferrara, Italy
Center for the Study of Hemostasis and Thrombosis, University of Ferrara, Ferrara, Italy
Cardiovascular Research Center, Salvatore Maugeri Foundation, IRCCS, Gussago, Italy
Erasmus Medical Center, Thoraxcenter, Rotterdam, the Netherlands
^|| Dipartimento di Scienze Biomediche e Chirurgiche, Cardiologia, Verona, Italy.

View larger version (18K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Platelet reactivity assays. Solid squares = patients with stable angina (SA); open squares = patients with ST-segment elevation myocardial infarction (STEMI); solid circles = abciximab subgroup; open circles = single high-dose bolus (SHDB) tirofiban subgroup. CADP = cartridge adenosine diphosphate closure time; T0 = baseline; T1 = 10 min after glycoprotein IIb/IIIa bolus; T2 = discharge.

View larger version (14K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Relationship between Thrombolysis In Myocardial Infarction (TIMI) flow grade before percutaneous coronary intervention (PCI) and baseline cartridge adenosine diphosphate (CADP) closure time (CADP-CT). Lower TIMI flow at first angiogram was associated with higher platelet reactivity (PR). CADP-CT was 73 ± 11 in the TIMI flow grade 0/1 group versus 87 ± 8 in the TIMI flow grade 2/3 group (p < 0.001), and % platelet aggregation was, respectively, 91 ± 4 versus 85 ± 3 (p < 0.001). CADP-CT was 75 ± 11 in the TIMI flow grade 0/1/2 group versus 89 ± 6 in the TIMI flow grade 3 group (p = 0.03), and %PA was, respectively, 90 ± 4 versus 84 ± 2 (p = 0.01).

View larger version (17K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Peak plasma levels of creatine kinase-MB (CK-MB) (top) and troponin I (bottom) are shown according to quartiles (Q) of CADP closure at admission. CADP-CT = cartridge adenosine diphosphate closure time.

View larger version (16K): [in this window] [in a new window] [Download PPT slide]   Figure 4 Cartridge adenosine diphosphate (CADP) closure time stratified in relation with the clinical outcome at 30 days and at 1 year. Solid circles = patients that not reached the composite end point; open circles = patients that reached the composite end point. MI = myocardial infarction; TVR = target vessel revascularization.

View larger version (15K): [in this window] [in a new window] [Download PPT slide]   Figure 5 Probability of major adverse cardiac events (MACE) in patients stratified according to PR measured with Platelet Function Analyzer-100. High platelet reactivity = CADP-CT at entry below the median value. Low platelet reactivity = CADP-CT at entry above the median value. Median value of CADP-CT is 75 s. Abbreviations as in Figures 1 and 2.