Related Experiment Video
Updated: Nov 5, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
The Association between Multi-Vessel Coronary Artery Disease and High On-Aspirin Platelet Reactivity
Arthur Shiyovich1, Liat Sasson2, Eli Lev2
1Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, and "Sackler" Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. arthur.shiyovich@gmail.com.
Insights
Multi-vessel coronary artery disease (MV-CAD) is linked to high on-aspirin platelet reactivity (HAPR). Patients with MV-CAD show significantly higher rates of HAPR compared to single-vessel disease, indicating a potential risk factor.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Multi-vessel coronary artery disease (MV-CAD) is associated with poorer clinical outcomes than single-vessel CAD (SV-CAD).
- Understanding factors influencing treatment efficacy in CAD is crucial for patient management.
Purpose of the Study:
- To investigate the association between MV-CAD and high on-aspirin platelet reactivity (HAPR).
- To assess HAPR in patients with stable CAD receiving aspirin therapy.
Main Methods:
- Analysis of prospectively enrolled patients with stable CAD on aspirin therapy.
- Coronary angiography used to define MV-CAD and SV-CAD.
- Platelet function testing (VerifyNow) to determine HAPR (ARU >550).
Main Results:
- 507 patients analyzed; 44% had MV-CAD.
- HAPR rate was significantly higher in MV-CAD (14.8%) versus SV-CAD (3.5%) (p < 0.001).
- MV-CAD independently predicted HAPR (OR=1.8, p=0.014), with a dose-response observed.
Conclusions:
- A significant association exists between MV-CAD and HAPR.
- MV-CAD is an independent predictor of HAPR in patients on aspirin.
- Further research into HAPR mechanisms and therapeutic strategies for MV-CAD patients is warranted.
Background:
Multi-vessel coronary artery disease (MV-CAD) is correlated with worse clinical outcomes compared with single-vessel CAD (SV-CAD). The aim of this study was to evaluate the association between MV-CAD and high on-aspirin platelet reactivity (HAPR) in patients with stable CAD treated with aspirin.
Methods:
The current study is an analysis of prospectively enrolled randomly selected patients with known stable CAD, who were taking aspirin (75-100 mg qd) regularly for at least one month, and had undergone coronary angiography at least 3 months prior to the enrollment to the study.
Exclusion Criteria:
acute coronary syndrome at the time of platelet function testing, active malignancy, acute infection, active inflammatory/rheumatic disease, major surgery in the past 6 months, chronic liver failure, treatment with oral anticoagulation, non-adherence with Aspirin and thrombocytopenia (<100 K/micl). Blood was drawn from the participants and sent for platelet function testing (VerifyNow, Instrumentation Laboratory Company, Bedford, Massachusetts, United States). MV-CAD was defined as >50% stenosis in ≥2 separate major coronary territories per coronary angiography. HAPR was defined as aspirin reaction units (ARU) >550.
Results:
Overall, 507 patients were analyzed; age 66.7 ± 11.2, 17.9% women, 223 (44%) had MV-CAD. The rate of HAPR was significantly higher among patients with MV-CAD vs. SV-CAD (14.8% vs. 3.5%, p < 0.001, respectively). Furthermore, a "dose response"-like association was found between the number of stenotic coronary arteries and the rate of HAPR (3.5%, 13.5 and 17.3% for SV-CAD, 2-vessel and 3-vessel disease, respectively). In a multivariate analysis adjusted for potential confounders, MV-CAD was found to be a strong independent predictor of HAPR [OR = 1.8 (95%CI: 1.05-4.7), p = 0.014].
Conclusions:
A significant association between MV-CAD and HAPR was found. Additional studies designed to investigate the mechanisms of HAPR and different therapeutic options for this subset of patients are warranted.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:27Coronary Artery Disease V: Interprofessional Care
01:26Coronary Artery Disease II: Pathophysiology
01:30Coronary Artery Disease I: Introduction
01:22Formation of the Platelet Plug
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
01:30Peripheral Artery Disease I: Introduction