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Published on: January 9, 2026
Multiple electrode aggregometry predicts stent thrombosis better than the vasodilator-stimulated phosphoprotein
J M Siller-Matula1, G Christ, I M Lang
1Department of Clinical Pharmacology, Medical University of Vienna, and 5th Medical Department, Kaiser-Franz-Josef Hospital, Vienna, Austria.
Insights
Multiple electrode aggregometry (MEA) better predicts stent thrombosis risk than the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay in patients undergoing percutaneous coronary intervention.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Diagnostics
Background:
- The prognostic value of VASP phosphorylation assay and MEA for thrombotic events is known.
- No direct comparison between VASP assay and MEA for predicting stent thrombosis exists.
Purpose of the Study:
- To compare the predictive value of VASP phosphorylation assay and MEA for stent thrombosis.
- To determine which laboratory approach is superior for risk stratification in patients undergoing PCI.
Main Methods:
- VASP phosphorylation assay and MEA were performed in 416 patients with coronary artery disease undergoing PCI.
- Stent thrombosis events were monitored over a 6-month follow-up period.
- Receiver operating characteristic (ROC) analysis was used for comparison.
Main Results:
- MEA demonstrated a higher area under the ROC curve (0.92) compared to VASP assay (0.60) in predicting stent thrombosis.
- At 100% sensitivity, MEA showed higher specificity (86%) than VASP assay (37%).
- Patients with MEA-defined platelet hyperreactivity and VASP-defined clopidogrel non-response had a 9% rate of stent thrombosis.
Conclusions:
- Platelet hyperreactivity assessed by MEA may be a more robust predictor of stent thrombosis than VASP assay's assessment of clopidogrel response.
- MEA could offer superior risk stratification for stent thrombosis in PCI patients.
Background And Aim:
The prognostic value of the vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay and multiple electrode aggregometry (MEA) for thrombotic adverse events has been shown in independent studies. As no direct comparison between the two methods has been made so far, we investigated which laboratory approach has a better predictive value for stent thrombosis.
Methods:
The VASP phosphorylation assay and MEA were performed in 416 patients with coronary artery disease undergoing percutaneous coronary intervention. The rate of stent thrombosis was recorded during a 6-month follow-up.
Results:
Definite stent thrombosis occurred in three patients (0.7%) and probable stent thrombosis in four (1%). Receiver operating characteristic (ROC) analysis demonstrated that MEA distinguishes between patients with or without subsequent stent thrombosis better than the VASP phosphorylation assay: the area under the ROC curve was higher for MEA (0.92; P=0.012) than for the VASP phosphorylation assay (0.60; P=0.55). At equal levels of sensitivity (100%), the specificity was greater for MEA than for the VASP phosphorylation assay (86% vs. 37%). Stent thrombosis occurred in 9% of patients with platelet hyperreactivity in MEA, who were simultaneously clopidogrel non-responders in the VASP phosphorylation assay. Interestingly, clopidogrel non-responders in the VASP phosphorylation assay without platelet hyperreactivity in MEA did not suffer from stent thrombosis.
Conclusions:
Platelet hyperreactivity in MEA might be a better risk predictor for stent thrombosis than the assessment of the specific clopidogrel effect with the VASP phosphorylation assay.
