Abstract 17930: Differences in Baseline Arterial and Venous Platelet Reactivity in Stable and Unstable Coronary Artery Disease

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A17930-A17930
• Main Authors: Al’Aref, Subhi J, Lombardo, Marissa A, Feldman, Dmitriy N, Kim, Luke K, Minutello, Robert M, Singh, Harsimran S, Bergman, Geoffrey, Wong, S.Chiu, Swaminathan, Rajesh V
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionP2Y12 inhibition is the basis of treatment in patients with ischemic heart disease and those undergoing coronary stenting. Baseline and residual platelet reactivity as well as efficacy of P2Y12 inhibition have been examined via platelet function assays based on peripheral venous blood sampling.HypothesisWe sought to examine regional differences in baseline platelet reactivity between the coronary and peripheral venous and arterial circulation.MethodsTwenty-three P2Y12 inhibitor-naïve patients undergoing coronary angiography were enrolled. Regional differences in baseline platelet reactivity, measured through the VerifyNow P2Y12 assay, were determined between near simultaneous collections of blood samples drawn from the peripheral vein (PV), femoral artery (FA), right (RCA) and left (LCA) coronary arteries.ResultsMean age was 60.1 ± 10.8 years and 61% were male patients. Clinically, 39% of the patients presented with stable angina, 26% presented with unstable angina and 35% presented with a non-ST elevation myocardial infarction (NSTEMI). Mean platelet reactivity was significantly lower in the PV (237.5 ± 45.3 PRU units) compared with the FA (255.2 ± 47.4 PRU units), LCA (261.4 ± 48.1 PRU units) and RCA (283.5 ± 41.7 PRU units) (P values < 0.01). When normalized to FV, platelet reactivity was consistently higher in the RCA across all subgroups, including diabetics and patients with renal insufficiency. Differences in platelet reactivity were accentuated in patients presenting with unstable angina, compared with stable angina and NTEMI presentations (5.8% higher reactivity in FA, 9.1% in LCA and 21.0% in the RCA in stable angina versus 11.5% in FA, 12.6% in LCA and 28.5% in the RCA in unstable angina and 5.1% in FA, 8.4% in LCA and 17.6% in the RCA in NSTEMI).ConclusionsIntra-coronary platelet reactivity differs significantly from peripheral venous and arterial circulation. Across various subgroups, platelet reactivity is highest in the coronary circulation, particularly in the right coronary artery, and lowest in the peripheral vein.