High post-treatment platelet reactivity is associated with a high incidence of myonecrosis after stenting for non-ST elevation acute coronary syndromes

Thomas Cuisset; Corinne Frere; Jacques Quilici; Pierre-Emmanuel Morange; Lyassine Nait-Saidi; Christopher Mielot; Laurent Bali; Marc Lambert; Marie-Christine Alessi; Jean-Louis Bonnet

doi:10.1160/TH06-07-0362

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2007; 97(02): 282-287
DOI: 10.1160/TH06-07-0362

Cardiovascular Biology and Cell Signalling

Schattauer GmbH

High post-treatment platelet reactivity is associated with a high incidence of myonecrosis after stenting for non-ST elevation acute coronary syndromes

Thomas Cuisset

¹Department of Cardiology, CHU Timone, Marseille, France

,

Corinne Frere

²INSERM, UMR 626, Faculté de Médecine CHU Timone, Marseille, France

,

Jacques Quilici

¹Department of Cardiology, CHU Timone, Marseille, France

,

Pierre-Emmanuel Morange

²INSERM, UMR 626, Faculté de Médecine CHU Timone, Marseille, France

,

Lyassine Nait-Saidi

¹Department of Cardiology, CHU Timone, Marseille, France

,

Christopher Mielot

¹Department of Cardiology, CHU Timone, Marseille, France

,

Laurent Bali

¹Department of Cardiology, CHU Timone, Marseille, France

,

Marc Lambert

¹Department of Cardiology, CHU Timone, Marseille, France

,

Marie-Christine Alessi

²INSERM, UMR 626, Faculté de Médecine CHU Timone, Marseille, France

,

Jean-Louis Bonnet

¹Department of Cardiology, CHU Timone, Marseille, France

› Author Affiliations

Abstract

Summary

High post-treatment platelet reactivity (HPPR= adenosine diphosphate [ADP] 10 µM-induced platelet aggregation > 70%) identifies low responders to dual antiplatelet therapy with increased risk of recurrent cardiovascular (CV) events after stenting for non-ST elevation acute coronary syndromes (NSTEACS). This study was designed to compare the incidence of periprocedural myocardial infarction (MI) after stenting for NSTEACS patients between non-responders to dual antiplatelet therapy defined by HPPR and normo-responders. One hundred ninety NSTE-ACS consecutive patients undergoing coronary stenting were included in this prospective study. They received 250 mg aspirin and a 600 mg loading dose of clopidogrel at least 12 hours (h) before percutaneous coronary intervention (PCI). A single post-treatment blood sample was obtained before PCI to analyze maximal intensity of ADP-induced platelet aggregation, and troponin levels were analyzed before PCI, and 12 and 24 h after PCI. Troponin I was considered elevated if > 0.4 ng/ ml. HPPR was present in 22% of patients (n=42). Periprocedural MI occurred significantly more frequently in patients with HPPR than in the normo-responders (43% vs. 24%, p=0.014). After being correlated with recurrent ischemic events after stenting for NSTE-ACS, the HPPR seems to be also a marker of increased risk of periprocedural MI for NSTE-ACS patients.

Keywords

Acute coronary syndromes - stenting - platelet reactivity - periprocedural myocardial infarction

Full Text

References

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