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Thromb Haemost 2018; 118(02): 415-426
DOI: 10.1160/TH17-08-0564
Atherosclerosis and Ischaemic Disease
Schattauer GmbH Stuttgart

Prognostic Implications of Dual Platelet Reactivity Testing in Acute Coronary Syndrome

Leonardo P. de Carvalho
,
Alan Fong
,
Richard Troughton
,
Bryan P. Yan
,
Chee-Tang Chin
,
Sock-Cheng Poh
,
Melissa Mejin
,
Nancy Huang
,
Aruni Seneviratna
,
Chi-Hang Lee
,
Adrian F. Low
,
Huay-Cheem Tan
,
Siew-Pang Chan
,
Christopher Frampton
,
A. Mark Richards
,
Mark Y. Chan
 Funding Sources The study was funded by the National Medical Research Council of Singapore (NMRC/CSA/028/2010) with platelet reactivity analysers and test kits supplied by Roche Diagnostics (Basel Switzerland). Both sponsors had no role in the study design, site selection, data collection, data analysis or data interpretation.
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Publikationsverlauf

16. August 2017

16. November 2017

Publikationsdatum:
29. Januar 2018 (online)

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Abstract

Studies on platelet reactivity (PR) testing commonly test PR only after percutaneous coronary intervention (PCI) has been performed. There are few data on pre- and post-PCI testing. Data on simultaneous testing of aspirin and adenosine diphosphate antagonist response are conflicting. We investigated the prognostic value of combined serial assessments of high on-aspirin PR (HASPR) and high on-adenosine diphosphate receptor antagonist PR (HADPR) in patients with acute coronary syndrome (ACS). HASPR and HADPR were assessed in 928 ACS patients before (initial test) and 24 hours after (final test) coronary angiography, with or without revascularization. Patients with HASPR on the initial test, compared with those without, had significantly higher intraprocedural thrombotic events (IPTE) (8.6 vs. 1.2%, p ≤ 0.001) and higher 30-day major adverse cardiovascular and cerebrovascular events (MACCE; 5.2 vs. 2.3%, p = 0.05), but not 12-month MACCE (13.0 vs. 15.1%, p = 0.50). Patients with initial HADPR, compared with those without, had significantly higher IPTE (4.4 vs. 0.9%, p = 0.004), but not 30-day (3.5 vs. 2.3%, p = 0.32) or 12-month MACCE (14.0 vs. 12.5%, p = 0.54). The c-statistic of the Global Registry of Acute Coronary Events (GRACE) score alone, GRACE score + ASPR test and GRACE score + ADPR test for discriminating 30-day MACCE was 0.649, 0.803 and 0.757, respectively. Final ADPR was associated with 30-day MACCE among patients with intermediate-to-high GRACE score (adjusted odds ratio [OR]: 4.50, 95% confidence interval [CI]: 1.14–17.66), but not low GRACE score (adjusted OR: 1.19, 95% CI: 0.13–10.79). In conclusion, both HASPR and HADPR predict ischaemic events in ACS. This predictive utility is time-dependent and risk-dependent.

Keywords

antiplatelet therapy - acute coronary syndrome - thrombosis

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