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Predictive values of post-clopidogrel platelet reactivity assessed by different platelet function tests on ischemic

Hong-Zhe Zhang1, Moo Hyun Kim, Young-Hoon Jeong

  • 1Department of Cardiology, Dong-A University Hospital , Busan , South Korea .

Platelets
|August 27, 2013
PubMed

Insights

High platelet reactivity after percutaneous coronary intervention (PCI) increases ischemic events. Light transmittance aggregometry (LTA) and VerifyNow assays effectively predict these events, unlike MEA, with cut-off values varying by sampling time.

Area of Science:

  • Cardiology
  • Clinical Trials
  • Biomarkers

Background:

  • Elevated platelet reactivity post-percutaneous coronary intervention (PCI) is linked to increased ischemic events.
  • Accurate prediction of these events is crucial for patient management.
  • Standardized assays are needed to assess platelet function effectively.

Purpose of the Study:

  • To evaluate the predictive value of three platelet function assays for early clinical outcomes in Korean patients undergoing PCI.
  • To determine optimal cut-off values for light transmittance aggregometry (LTA), VerifyNow P2Y12 assay, and multiple electrode platelet aggregometry (MEA) in predicting post-PCI ischemic events.

Main Methods:

  • A prospective study involving 228 Korean patients receiving clopidogrel before PCI.
  • Platelet reactivity was measured using LTA, VerifyNow, and MEA assays at pre-PCI, PCI, and post-PCI time points.
  • The primary endpoint was the occurrence of ischemic events within 30 days post-PCI, including periprocedural myocardial infarction (MI) and death.

Main Results:

  • 36 patients (15.8%) experienced MACE, with 35 (15.4%) having periprocedural MI.
  • Higher LTA and VerifyNow values (pre- and post-PCI) were significantly associated with periprocedural MI.
  • MEA assay results did not show significant differences in predicting periprocedural MI (p=0.25 pre-PCI, p=0.33 post-PCI).
  • ROC analysis identified predictive cut-off values for LTA and VerifyNow, indicating their ability to discriminate risk.
  • Optimal cut-off values were dependent on the sampling time (pre-PCI vs. post-PCI).

Conclusions:

  • Platelet reactivity measurements using LTA and VerifyNow assays can effectively predict 30-day ischemic events after PCI.
  • The MEA assay demonstrated limited predictive value in this patient cohort.
  • The identified predictive cut-off values highlight the importance of assay selection and sampling time for risk stratification in patients undergoing PCI.

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