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Updated: May 12, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Comparison of Platelet Function Tests for Long-Term Cardiovascular Events after Percutaneous Coronary Interventions
Mingyao Zhou1, Pan Hou1,2, Ying Liang1
1Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China.
Insights
High on-treatment platelet reactivity (HTPR) in acute coronary syndrome (ACS) patients increases major adverse cardiovascular events (MACEs). VerifyNow testing effectively predicts long-term MACEs, outperforming other platelet function tests.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- High on-treatment platelet reactivity (HTPR) in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) is linked to increased major adverse cardiovascular events (MACEs).
- Several platelet function tests exist, but their correlation and prognostic value for MACEs in ACS patients remain unclear.
Purpose of the Study:
- To prospectively evaluate the consistency and effectiveness of four platelet function detection methods in predicting long-term MACEs in ACS patients treated with clopidogrel.
- To compare the predictive capabilities of thrombelastography (TEG), vasodilator-stimulated phosphoprotein (VASP), PL-11, and VerifyNow assays.
Main Methods:
- A prospective study involving 98 ACS patients undergoing PCI treated with clopidogrel.
- Assessment of HTPR using VerifyNow (P2Y12 reaction units [PRUs] >240), TEG, VASP, and PL-11.
- Long-term follow-up for MACEs (cardiac death, nonfatal myocardial infarction, target vessel revascularization).
Main Results:
- VerifyNow detected HTPR in 27.6% of patients. Incidence of HTPR varied significantly across tests (TEG: 58.2%, VASP: 52%, PL-11: 13.3%).
- VerifyNow and TEG demonstrated the highest consistency in HTPR detection (kappa = 0.201, p = 0.015).
- During a median 6.1-year follow-up, 29 MACEs occurred. VerifyNow-detected HTPR independently predicted long-term MACEs (HR: 5.73, 95% CI: 2.04-16.09, p = 0.001).
Conclusions:
- VerifyNow-detected high on-treatment platelet reactivity is a robust independent predictor of long-term MACEs in ACS patients undergoing PCI.
- The predictive model incorporating traditional risk factors and VerifyNow results showed superior discrimination for MACEs (AUC = 0.889).
- VerifyNow offers superior predictive discrimination for MACEs compared to TEG, VASP, and PL-11 in this patient cohort.
Abstract:
Patients with high on-treatment platelet reactivity (HTPR) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) face increased risks of major adverse cardiovascular events (MACEs). Although platelet function tests like thrombelastography (TEG), vasodilator-stimulated phosphoprotein (VASP), PL-11, and VerifyNow have been described, the correlation between them and their prognostic implications remains uncertain. This prospective study aims to evaluate the consistency and effectiveness of four platelet function detection methods in predicting long-term MACEs in patients with ACS. All 98 ACS patients undergoing PCI with clopidogrel were assessed for HTPR using four platelet function detection methods. The endpoint was the occurrence of MACEs, including cardiac death, nonfatal myocardial infarction (MI), and target vessel revascularization (TVR). Among 98 patients enrolled from April 1, 2014 to June 30, 2014, 27 (27.6%) patients with VerifyNow-detected HTPR (P2Y12 reaction units [PRUs] >240). The incidence of HTPR was 58.2% for TEG, 52% for VASP, and 13.3% for PL-11. VerifyNow and TEG showed the highest consistency in detecting HTPR (kappa = 0.201, p = 0.015). During a median follow-up of 6.1 years, 29 MACEs occurred, including 24 TVRs, 3 cardiovascular deaths, and 2 nonfatal MIs. VerifyNow-detected HTPR independently predicted long-term MACEs (hazard ratio: 5.73, 95% confidence interval: 2.04-16.09, p = 0.001), even after adjusting for traditional risk factors (TRFs). Receiver operating characteristic (ROC) analysis indicated that the model incorporating TRFs and VerifyNow-detected HTPR had superior predictive discrimination for MACEs (area under ROC curve = 0.889). VerifyNow-detected HTPR independently emerges as a robust predictor for long-term MACEs, demonstrating superior predictive discrimination compared with other platelet function tests.
