Effect of Platelet Reactivity, Endothelial Function, and Inflammatory Status on Outcomes in Patients With Stable Angina Pectoris on Clopidogrel Therapy

• Published in: The American journal of cardiology 2014-03, Vol.113 (5), p.786-792
• Main Authors: Woo, Jong Shin, MD, Kim, Weon, MD, PhD, Jang, Hyun Hee, MS, Kim, Jin Bae, MD, PhD, Kim, Woo-Shik, MD, PhD, Kim, Kwon Sam, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Angina, Stable - drug therapy; Angina, Stable - physiopathology; Blood Platelets - drug effects; Brachial Artery - diagnostic imaging; Cardiovascular; Cell Count; Endothelium, Vascular - cytology; Endothelium, Vascular - drug effects; Endothelium, Vascular - physiopathology; Female; Humans; Male; Middle Aged; Multivariate Analysis; Platelet Activation - drug effects; Platelet Activation - physiology; Platelet Aggregation Inhibitors - pharmacology; Platelet Aggregation Inhibitors - therapeutic use; Stem Cells; Ticlopidine - analogs & derivatives; Ticlopidine - pharmacology; Ticlopidine - therapeutic use; Ultrasonography
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.11.025

Although high on-treatment platelet reactivity (HTPR) is an important predictor of clinical outcomes in patients undergoing coronary stenting, it is unknown whether endothelial dysfunction and HTPR are associated. We examined the platelet function, peripheral vascular function, endothelial progenitor cell (EPC) number, platelet activation markers, high-sensitivity C-reactive protein (hs-CRP) level, and clinical outcomes in patients receiving chronic clopidogrel therapy. We consecutively enrolled 91 patients who underwent follow-up angiography because of chest discomfort. All patients took aspirin and clopidogrel for an average of 498 ± 138 days. Platelet reactivity was assessed by light transmittance aggregometry (maximal platelet aggregation by 5 μmol/L of adenosine diphosphate ≤50% in group 1 [optimal response] and >50% as group 2 [HTPR]). Flow-mediated dilation of the brachial artery and brachial-ankle pulse wave velocity (PWV), numbers of EPCs isolated from peripheral blood, platelet activation markers (soluble CD40 ligand and soluble P-selectin), and hs-CRP levels were assessed before follow-up angiography. There were no significant differences in baseline characteristics and previous percutaneous coronary intervention (PCI) data between groups 1 (n = 59) and 2 (n = 32). Group 2 showed poorer flow-mediated dilation (6.1 ± 4.1% vs 12.9 ± 6.2%, p