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The prognostic value of multiple electrode aggregometry and light transmittance aggregometry in stable cardiovascular
Argirios E Tsantes1, Maria Taichert1, Elias Kyriakou1
1Laboratory of Haematology and Blood Bank Unit, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Light transmittance aggregometry (LTA) predicts cardiovascular death risk in type 2 diabetes mellitus patients with coronary artery disease, unlike multiple electrode aggregometry (MEA). LTA offers prognostic value for these high-risk patients.
Area of Science:
- Cardiology
- Clinical Chemistry
- Diabetes Mellitus Research
Background:
- Platelet function testing is crucial for managing patients with coronary artery disease (CAD) on dual antiplatelet therapy.
- Limited data exist on the clinical relevance of platelet function measurements in stable CAD patients with type 2 diabetes mellitus (T2DM).
- Evaluating agreement between aggregometry methods and their prognostic value is essential for optimizing patient care.
Purpose of the Study:
- To assess the agreement between multiple electrode aggregometry (MEA) and light transmittance aggregometry (LTA) in identifying clopidogrel low responders.
- To determine the prognostic value of these platelet function tests in predicting major adverse cardiovascular events (MACE) in stable T2DM patients with CAD.
- To establish optimal cutoff values for predicting cardiovascular outcomes.
Main Methods:
- 122 stable cardiovascular patients with T2DM undergoing dual antiplatelet therapy were enrolled.
- Platelet function was assessed using LTA and MEA, with low responders defined by the upper quartile of measurements.
- Agreement was evaluated using kappa statistics, and prognostic value was assessed via logistic regression and ROC analysis over a 1-year follow-up.
Main Results:
- Fair agreement (kappa=0.214) was observed between LTA and MEA.
- A total of 25 MACE occurred. Patients with MACE showed higher LTAmax values (p=0.023), while MEA measurements did not differ significantly.
- LTAmax response independently predicted cardiovascular death (aOR=0.2; 95% CI: 0.05-0.81), with a cutoff of 62.5% showing optimal prediction (AUC=0.67).
Conclusions:
- Platelet function assessment is highly test-specific.
- LTA demonstrates prognostic value for predicting death risk in stable T2DM patients with CAD.
- MEA testing did not show significant prognostic value in this patient cohort.
Aim:
Limited data are available regarding the clinical relevance of platelet function measurements in stable patients with coronary artery disease (CAD). Our aim is to evaluate the agreement between multiple electrode aggregometry (MEA) and light transmittance aggregometry (LTA) in detecting clopidogrel low responders and their prognostic value in CAD patients with type 2 diabetes mellitus (T2DM) on dual platelet inhibition.
Methods:
LTA and MEA were performed in 122 stable cardiovascular patients with T2DM. The upper quartile of patients according to maximum LTA (LTAmax) and MEA measurements were defined as clopidogrel low responders. Agreement between the two methods was evaluated by kappa statistics. We assessed the potential correlation between antiplatelet response and clinical outcome and the optimal cutoff value according to ROC analysis to predict the occurrence of major adverse cardiovascular events (MACE), during 1-year follow-up period.
Results:
Cohen's kappa coefficients (0.214) indicated fair agreement (70.2%) between LTA and MEA. A total of 25 MACE occurred in 108 patients (23.1%). Patients with MACE had higher LTAmax than those without (57.1 ± 16.5 vs 49.3 ± 18.3, respectively, p = 0.023). MEA measurements were similar between patients with and without MACE (30.1 ± 15.4 vs 30.6 ± 20.8, respectively; p = 0.84). Multiple logistic regression showed LTAmax response as an independent predictor of death from cardiovascular causes (Odds Ratio, adjusted:0.2;0.05-0.81). ROC analysis indicated that LTAmax cutoff of 62.5% best predicted death (AUC = 0.67, sensitivity = 78%, specificity = 61.5%).
Conclusions:
The assessment of platelet responsiveness remains highly test-specific. Our results support the prognostic role of LTA, but not MEA testing, for death risk evaluation in stable cardiovascular T2DM patients.
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