On-Ticagrelor Platelet Reactivity and Clinical Outcome in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

Marc Laine; Vassili Panagides; Corinne Frère; Thomas Cuisset; Caroline Gouarne; Bernard Jouve; Gilles Lemesle; Franck Paganelli; Marie-Christine Alessi; Julien Mancini; Laurent Bonello

doi:10.1055/a-1326-5110

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2021; 121(07): 923-930
DOI: 10.1055/a-1326-5110

Cellular Haemostasis and Platelets

On-Ticagrelor Platelet Reactivity and Clinical Outcome in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

Marc Laine

¹Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France

,

Vassili Panagides

¹Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France

,

Corinne Frère

²Institute of Cardiometabolism And Nutrition, INSERM UMRS_1166, GRC 27 GRECO, Sorbonne Université, Paris, France

³Department of Haematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France

,

Thomas Cuisset

⁴Department of Cardiology, CHU Timone, Marseille, France

,

Caroline Gouarne

¹Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France

³Department of Haematology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France

,

Bernard Jouve

⁵Department of Cardiology, Hospital of Aix-en-Provence, F-13100 Aix-en-Provence, France

,

Gilles Lemesle

⁶USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, Lille, France

⁷Faculté de Médecine de l'Université de Lille, Lille, France

⁸INSERM UMR 1011, Institut Pasteur de Lille, Lille, France

⁹FACT (French Alliance for Cardiovascular Trials), Paris, France

,

Franck Paganelli

¹Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France

,

Marie-Christine Alessi

¹⁰Centre for CardioVascular and Nutrition Research (C2VN), INSERM 1263, INRA 1260, Marseille, France

,

Julien Mancini

¹¹Assistance Publique-Hôpitaux de Marseille, INSERM, IRD, SESSTIM, CHU Timone, Department of Public Health (BIOSTIC), Aix Marseille Université, Marseille, France

,

Laurent Bonello

¹Intensive care Unit, Department of Cardiology, Assistance publique des hopitaux de Marseille, Hôpital Nord, Aix Marseille University, Mediterranean Association for Research and Studies in Cardiology (MARS Cardio), Marseille, France

› Author Affiliations

Abstract

Background A strong association between on-thienopyridine platelet reactivity (PR) and the risk of both thrombotic and bleeding events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) has been demonstrated. However, no study has analyzed the relationship between on-ticagrelor PR and clinical outcome in this clinical setting.

Objectives We aimed to investigate the relationship between on-ticagrelor PR, assessed by the vasodilator-stimulated phosphoprotein (VASP) index, and clinical outcome in patients with ACS undergoing PCI.

Methods We performed a prospective, multicenter, observational study of patients undergoing PCI for ACS. PR was measured using the VASP index following ticagrelor loading dose. The primary study endpoint was the rate of Bleeding Academic Research Consortium (BARC) type ≥2 at 1 year. The key secondary endpoint was the rate of major adverse cardiovascular events (MACE) defined as the composite of cardiovascular death, myocardial infarction, stroke, and urgent revascularization.

Results We included 570 ACS patients, among whom 33.9% had ST-elevation myocardial infarction. BARC type ≥2 bleeding occurred in 10.9% and MACE in 13.8%. PR was not associated with BARC ≥2 or with MACE (p = 0.12 and p = 0.56, respectively). No relationship between PR and outcomes was observed, neither when PR was analyzed quantitatively nor when it was analyzed qualitatively (low on-treatment PR [LTPR] vs. no LTPR).

Conclusion On-ticagrelor PR measured by the VASP was not associated with bleeding or thrombotic events in ACS patients undergoing PCI. PR measured by the VASP should not be used as a surrogate endpoint in studies on ticagrelor.

Keywords

ticagrelor - platelet reactivity - VASP index - acute coronary syndrome - ADP receptor inhibitor

Full Text

References

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Supplementary Material

Supplementary Material