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Published on: October 14, 2016
Long Term Cardiovascular Outcome Based on Aspirin and Clopidogrel Responsiveness Status in Young ST-Elevated
Mustafa Umut Somuncu1, Ali Riza Demir2, Seda Tukenmez Karakurt2
1Bulent Ecevit University - Faculty of Medicine -, Department of Cardiology, Zonguldak - Turkey.
Insights
Young patients with ST-elevation myocardial infarction (STEMI) experiencing poor response to dual antiplatelet therapy face a significantly higher risk of recurrent cardiovascular events. This highlights the need for personalized treatment strategies in this high-risk group.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Recurrent cardiovascular events occur in some patients on antiplatelet therapy, potentially due to resistance.
- Assessing the impact of low response to aspirin or clopidogrel on patient outcomes is crucial.
Purpose of the Study:
- To determine the prevalence of poor response to dual antiplatelet therapy.
- To investigate the association between poor response and major adverse cardiovascular events (MACE) in young ST-elevation myocardial infarction (STEMI) patients.
Main Methods:
- 123 patients under 45 with STEMI undergoing primary percutaneous intervention were studied.
- Aspirin and clopidogrel responsiveness was screened on day five; patients were grouped by resistance status.
- A three-year follow-up was conducted to assess MACE.
Main Results:
- 48% of young STEMI patients showed resistance to at least one antiplatelet agent.
- Poor responders to dual therapy had higher MACE rates (OR: 1.875, p < 0.001).
- After adjustments, poor responders to dual therapy had 3.3 times increased odds of three-year MACE.
Conclusions:
- Dual antiplatelet therapy requires careful consideration in young STEMI patients.
- Increased cardiovascular event risk is associated with poor antiplatelet response in this population.
Background:
A subset of patients who take antiplatelet therapy continues to have recurrent cardiovascular events which may be due to antiplatelet resistance. The effect of low response to aspirin or clopidogrel on prognosis was examined in different patient populations.
Objective:
We aimed to investigate the prevalence of poor response to dual antiplatelet therapy and its relationship with major adverse cardiovascular events (MACE) in young patients with ST-elevation myocardial infarction (STEMI).
Methods:
In our study, we included 123 patients under the age of 45 with STEMI who underwent primary percutaneous intervention. A screening procedure to determine both aspirin and clopidogrel responsiveness was performed on the fifth day of admission. We followed a 2x2 factorial design and patients were allocated to one of four groups, according to the presence of aspirin and/or clopidogrel resistance. Patients were followed for a three-year period. A p-value less than 0.05 was considered statistically significant.
Results:
We identified 48% of resistance against one or more antiplatelet in young patients with STEMI. More MACE was observed in patients with poor response to dual platelet therapy or to clopidogrel compared those with adequate response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR: 1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential confounders, we found that poor responders to dual therapy had 3.3 times increased odds for three-year MACE than those with adequate response to the dual therapy.
Conclusion:
Attention should be paid to dual antiplatelet therapy in terms of increased risk for cardiovascular adverse events especially in young patients with STEMI.
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