Posttreatment platelet reactivity on clopidogrel is associated with the risk of adverse events after off-pump coronary artery bypass

Background Dual antiplatelet therapy with aspirin and clopidogrel is currently recommended in off-pump coronary artery bypass (OPCAB). However, no data exist concerning platelet reactivity on clopidogrel after OPCAB. The aim of this study was to assess the relationship between platelet reactivity an...

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Published in:The American heart journal 2014-06, Vol.167 (6), p.818-825
Main Authors: Youn, Young-Nam, MD, PhD, Yi, Gijong, MD, PhD, Lee, Sak, MD, PhD, Joo, Hyun-Chel, MD, Yoo, Kyung-Jong, MD, PhD
Format: Article
Language:English
Subjects:
Aged
Aspirin - therapeutic use
Blood Platelets - drug effects
Cardiovascular
Clinical outcomes
Cohort Studies
Colleges & universities
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease - drug therapy
Coronary Artery Disease - mortality
Coronary Artery Disease - surgery
Coronary vessels
Drug Resistance
Drug therapy
Drug Therapy, Combination
Female
Heart attacks
Humans
Male
Middle Aged
Myocardial Infarction - mortality
Myocardial Infarction - prevention & control
Myocardial Revascularization
Platelet Activation
Platelet Aggregation - drug effects
Platelet Aggregation Inhibitors - therapeutic use
Prospective Studies
ROC Curve
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
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cited_by cdi_FETCH-LOGICAL-c436t-60e2af39d05ac14829cda4cf6776cde81589441f7a2a01dad69dffe4e2ab6b5d3
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container_title The American heart journal
container_volume 167
creator Youn, Young-Nam, MD, PhD
Yi, Gijong, MD, PhD
Lee, Sak, MD, PhD
Joo, Hyun-Chel, MD
Yoo, Kyung-Jong, MD, PhD
description Background Dual antiplatelet therapy with aspirin and clopidogrel is currently recommended in off-pump coronary artery bypass (OPCAB). However, no data exist concerning platelet reactivity on clopidogrel after OPCAB. The aim of this study was to assess the relationship between platelet reactivity and late major adverse cardiovascular events (MACEs) after OPCAB. Methods In this prospective, single-center, observational study, on-clopidogrel platelet reactivity was measured using a point-of-care assay (VerifyNow system; Accumetrics Inc, San Diego, CA) in 859 patients who underwent OPCAB with 1 or more vein grafts. The primary end point was late MACEs (30 days–1 year) including cardiac death, nonfatal myocardial infarction, and target vessel revascularization. Receiver operating characteristic curve analysis was used to estimate the cutoff value of P2Y12 reaction units (PRUs) for MACEs. Results The optimal cutoff value for posttreatment reactivity for the incidence of late MACEs was ≥188 PRU (area under the curve 0.72, 95% CI 0.68-0.75, P = .002). The incidence of late MACEs was significantly higher in the high platelet reactivity (HPR; ≥188 PRU) group than in the low platelet reactivity (
doi_str_mv 10.1016/j.ahj.2014.01.016
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However, no data exist concerning platelet reactivity on clopidogrel after OPCAB. The aim of this study was to assess the relationship between platelet reactivity and late major adverse cardiovascular events (MACEs) after OPCAB. Methods In this prospective, single-center, observational study, on-clopidogrel platelet reactivity was measured using a point-of-care assay (VerifyNow system; Accumetrics Inc, San Diego, CA) in 859 patients who underwent OPCAB with 1 or more vein grafts. The primary end point was late MACEs (30 days–1 year) including cardiac death, nonfatal myocardial infarction, and target vessel revascularization. Receiver operating characteristic curve analysis was used to estimate the cutoff value of P2Y12 reaction units (PRUs) for MACEs. Results The optimal cutoff value for posttreatment reactivity for the incidence of late MACEs was ≥188 PRU (area under the curve 0.72, 95% CI 0.68-0.75, P = .002). The incidence of late MACEs was significantly higher in the high platelet reactivity (HPR; ≥188 PRU) group than in the low platelet reactivity (&lt;188 PRU) group (3.6% vs 1.4%, P = .040). Kaplan-Meier analysis revealed 1-year MACE-free survival rates of 98.4% ± 0.5% and 95.9% ± 1.3% in the low platelet reactivity and HPR groups, respectively ( P = .034). According to a Cox regression hazard model, HPR was an independent risk factor for late MACE-free survival (hazard ratio 3.51, 95% CI 1.27-9.69, P = .015). Conclusion High residual platelet reactivity after clopidogrel administration is strongly associated with 1-year MACE-free survival. Routine measurement of platelet reactivity and thorough monitoring of patients with HPR after OPCAB are warranted.</description><identifier>ISSN: 0002-8703</identifier><identifier>EISSN: 1097-6744</identifier><identifier>DOI: 10.1016/j.ahj.2014.01.016</identifier><identifier>PMID: 24890530</identifier><identifier>CODEN: AHJOA2</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aged ; Aspirin - therapeutic use ; Blood Platelets - drug effects ; Cardiovascular ; Clinical outcomes ; Cohort Studies ; Colleges &amp; universities ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease - drug therapy ; Coronary Artery Disease - mortality ; Coronary Artery Disease - surgery ; Coronary vessels ; Drug Resistance ; Drug therapy ; Drug Therapy, Combination ; Female ; Heart attacks ; Humans ; Male ; Middle Aged ; Myocardial Infarction - mortality ; Myocardial Infarction - prevention &amp; control ; Myocardial Revascularization ; Platelet Activation ; Platelet Aggregation - drug effects ; Platelet Aggregation Inhibitors - therapeutic use ; Prospective Studies ; ROC Curve ; Ticlopidine - analogs &amp; derivatives ; Ticlopidine - therapeutic use</subject><ispartof>The American heart journal, 2014-06, Vol.167 (6), p.818-825</ispartof><rights>Mosby, Inc.</rights><rights>2014 Mosby, Inc.</rights><rights>Copyright © 2014 Mosby, Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-60e2af39d05ac14829cda4cf6776cde81589441f7a2a01dad69dffe4e2ab6b5d3</citedby><cites>FETCH-LOGICAL-c436t-60e2af39d05ac14829cda4cf6776cde81589441f7a2a01dad69dffe4e2ab6b5d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24890530$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Youn, Young-Nam, MD, PhD</creatorcontrib><creatorcontrib>Yi, Gijong, MD, PhD</creatorcontrib><creatorcontrib>Lee, Sak, MD, PhD</creatorcontrib><creatorcontrib>Joo, Hyun-Chel, MD</creatorcontrib><creatorcontrib>Yoo, Kyung-Jong, MD, PhD</creatorcontrib><title>Posttreatment platelet reactivity on clopidogrel is associated with the risk of adverse events after off-pump coronary artery bypass</title><title>The American heart journal</title><addtitle>Am Heart J</addtitle><description>Background Dual antiplatelet therapy with aspirin and clopidogrel is currently recommended in off-pump coronary artery bypass (OPCAB). However, no data exist concerning platelet reactivity on clopidogrel after OPCAB. The aim of this study was to assess the relationship between platelet reactivity and late major adverse cardiovascular events (MACEs) after OPCAB. Methods In this prospective, single-center, observational study, on-clopidogrel platelet reactivity was measured using a point-of-care assay (VerifyNow system; Accumetrics Inc, San Diego, CA) in 859 patients who underwent OPCAB with 1 or more vein grafts. The primary end point was late MACEs (30 days–1 year) including cardiac death, nonfatal myocardial infarction, and target vessel revascularization. Receiver operating characteristic curve analysis was used to estimate the cutoff value of P2Y12 reaction units (PRUs) for MACEs. Results The optimal cutoff value for posttreatment reactivity for the incidence of late MACEs was ≥188 PRU (area under the curve 0.72, 95% CI 0.68-0.75, P = .002). The incidence of late MACEs was significantly higher in the high platelet reactivity (HPR; ≥188 PRU) group than in the low platelet reactivity (&lt;188 PRU) group (3.6% vs 1.4%, P = .040). Kaplan-Meier analysis revealed 1-year MACE-free survival rates of 98.4% ± 0.5% and 95.9% ± 1.3% in the low platelet reactivity and HPR groups, respectively ( P = .034). According to a Cox regression hazard model, HPR was an independent risk factor for late MACE-free survival (hazard ratio 3.51, 95% CI 1.27-9.69, P = .015). Conclusion High residual platelet reactivity after clopidogrel administration is strongly associated with 1-year MACE-free survival. Routine measurement of platelet reactivity and thorough monitoring of patients with HPR after OPCAB are warranted.</description><subject>Aged</subject><subject>Aspirin - therapeutic use</subject><subject>Blood Platelets - drug effects</subject><subject>Cardiovascular</subject><subject>Clinical outcomes</subject><subject>Cohort Studies</subject><subject>Colleges &amp; universities</subject><subject>Coronary Artery Bypass, Off-Pump</subject><subject>Coronary Artery Disease - drug therapy</subject><subject>Coronary Artery Disease - mortality</subject><subject>Coronary Artery Disease - surgery</subject><subject>Coronary vessels</subject><subject>Drug Resistance</subject><subject>Drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - prevention &amp; control</subject><subject>Myocardial Revascularization</subject><subject>Platelet Activation</subject><subject>Platelet Aggregation - drug effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Prospective Studies</subject><subject>ROC Curve</subject><subject>Ticlopidine - analogs &amp; 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However, no data exist concerning platelet reactivity on clopidogrel after OPCAB. The aim of this study was to assess the relationship between platelet reactivity and late major adverse cardiovascular events (MACEs) after OPCAB. Methods In this prospective, single-center, observational study, on-clopidogrel platelet reactivity was measured using a point-of-care assay (VerifyNow system; Accumetrics Inc, San Diego, CA) in 859 patients who underwent OPCAB with 1 or more vein grafts. The primary end point was late MACEs (30 days–1 year) including cardiac death, nonfatal myocardial infarction, and target vessel revascularization. Receiver operating characteristic curve analysis was used to estimate the cutoff value of P2Y12 reaction units (PRUs) for MACEs. Results The optimal cutoff value for posttreatment reactivity for the incidence of late MACEs was ≥188 PRU (area under the curve 0.72, 95% CI 0.68-0.75, P = .002). The incidence of late MACEs was significantly higher in the high platelet reactivity (HPR; ≥188 PRU) group than in the low platelet reactivity (&lt;188 PRU) group (3.6% vs 1.4%, P = .040). Kaplan-Meier analysis revealed 1-year MACE-free survival rates of 98.4% ± 0.5% and 95.9% ± 1.3% in the low platelet reactivity and HPR groups, respectively ( P = .034). According to a Cox regression hazard model, HPR was an independent risk factor for late MACE-free survival (hazard ratio 3.51, 95% CI 1.27-9.69, P = .015). Conclusion High residual platelet reactivity after clopidogrel administration is strongly associated with 1-year MACE-free survival. Routine measurement of platelet reactivity and thorough monitoring of patients with HPR after OPCAB are warranted.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>24890530</pmid><doi>10.1016/j.ahj.2014.01.016</doi><tpages>8</tpages></addata></record>
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subjects Aged
Aspirin - therapeutic use
Blood Platelets - drug effects
Cardiovascular
Clinical outcomes
Cohort Studies
Colleges & universities
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease - drug therapy
Coronary Artery Disease - mortality
Coronary Artery Disease - surgery
Coronary vessels
Drug Resistance
Drug therapy
Drug Therapy, Combination
Female
Heart attacks
Humans
Male
Middle Aged
Myocardial Infarction - mortality
Myocardial Infarction - prevention & control
Myocardial Revascularization
Platelet Activation
Platelet Aggregation - drug effects
Platelet Aggregation Inhibitors - therapeutic use
Prospective Studies
ROC Curve
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
title Posttreatment platelet reactivity on clopidogrel is associated with the risk of adverse events after off-pump coronary artery bypass
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