Abstract An accumulating number of studies are revealing that platelet reactivity above specific cut-off scores leads to exponentially increased rates of post-percutaneous coronary intervention (PCI) ischemic events. To evaluate the optimal predictive values for three different platelet function measurement assays of platelet reactivity on early clinical outcomes in Korean patients undergoing PCI, we enrolled 228 patients receiving clopidogrel prior to PCI. Platelet reactivity was measured by light transmittance aggregometry (LTA), VerifyNow P2Y12 assay, and multiple electrode platelet aggregometry (MEA). The primary endpoint was the 30-day occurrence of ischemic events after PCI. MACE occurred in 36 patients (15.8%), including 35 patients (15.4%) with periprocedural MI and the death of one patient (0.4%). ADP-induced LTA and VerifyNow values (pre- and post-PCI) were significantly higher in patients with the subsequent occurrence of periprocedural MI, but the MEA assay data (PCI and post-PCI) displayed no significant differences (pre-PCI p=0.25 and post-PCI p=0.33). ROC curve analysis demonstrated HPR values for LTA (pre-PCI, >66% and post-PCI, >53 %, all p<0.001), VerifyNow (pre-PCI, >347 PRU and post-PCI >272 PRU, all p<0.001) and MEA (pre-PCI, >50 U and post-PCI >39 U, all p>0.05). The platelet reactivity measurements by LTA and the VerifyNow assay can discriminate the risk of 30-day ischemic events after PCI. The predictive cut-off values for adverse events are dependent on sampling time.

译文

摘要越来越多的研究表明,超过特定临界值的血小板反应性导致经皮冠状动脉介入治疗 (PCI) 后缺血性事件的发生率呈指数增加。为了评估三种不同的血小板功能测量测定对接受PCI的韩国患者早期临床结局的最佳预测值,我们招募了228例在PCI之前接受氯吡格雷的患者。通过透光率聚集法 (LTA),VerifyNow P2Y12测定和多电极血小板聚集法 (MEA) 测量血小板反应性。主要终点是PCI术后30天发生缺血事件。MACE发生在36例患者 (15.8% 例) 中,其中35例 (15.4% 例) 患有围手术期MI,1例死亡 (0.4% 例)。在随后发生围手术期MI的患者中,ADP诱导的LTA和VerifyNow值 (PCI前和PCI后) 显着较高,但MEA测定数据 (PCI和PCI后) 显示无显着差异 (PCI前p = 0.25和PCI后p = 0.33)。ROC曲线分析显示了LTA (PCI前,> 66% 和PCI后,> 53%,所有p<0.001) 、VerifyNow (PCI前,> 347 PRU和PCI后> 272 PRU,所有p<0.001) 和MEA (PCI前,> 50 U和PCI后> 39 U,所有p>0.05)。通过LTA和VerifyNow分析进行的血小板反应性测量可以区分PCI后30天缺血事件的风险。不良事件的预测临界值取决于采样时间。

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