Abstract 13763: Peri-Procedual Myocardial Injury Does not Correlate with Resistance of On-Clopidogrel Platelet Aggregation in Elective Percutaneous Coronary Intervention
The Joint ESC/ACCF/AHA/WHF Task Force has reported the definition of percutaneous coronary intervention (PCI)-related myocardial infarction in patients with normal baseline cardiac biomarker levels. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is shown to reduce increased risk of events after PCI. However, there is no report showing the relation between PCI-related peri-procedual myocardial injury (PMI) and the resistance of on-clopidogrel residual platelet aggregation (RPA) in patients undergoing elective PCI. We measured serial changes of plasma high-sensitive troponin T (hs-TnT) levels and RPA induced by ADP using light transmittance aggregometry in 108 patients undergoing PCI (PCI group). Thirty patients who did not receive PCI were enrolled as control group. Blood samples were obtained before, 24, and 48 hours after PCI, or before and 24 hours after coronary angiography (CAG) in control group. PMI was defined as plasma hs-TnT levels 24 hours after PCI greater than 3×99th percentile URL of hs-TnT levels. Plasma hs-TnT levels were identical before and 24 hours after CAG in control group. Plasma hs-TnT levels were significantly higher 24 hours after PCI compared with before PCI (17.9±14.5 vs. 86.8±121.5 pg/ml, P<0.003). Plasma hs-TnT levels peaked at 24 hours after PCI and returned close to baseline levels at 4 weeks after PCI. PMI were observed in 41 (45%) out of 108 patients. Simple logistic analysis revealed that PMI were correlated with age [odds ratio (OR) 2.48; 95% confidence interval (CI): 1.01 to 6.07; p=0.044], estimated glomerular filtration rate (OR 3.81; 95% CI: 1.51 to 9.61; p=0.004), hemoglobin (OR 2.74; 95% CI: 1.17 to 6.43; p=0.019) and stent length (OR 5.01; 95% CI: 2.01 to 12.47; p=0.001), respectively. Multiple logistic regression analysis identified the stent length as the significant and independent predictors of PMI (odds ratio 4.36; 95% CI: 1.68 to 11.36; p=0.0026). PMI did not influence the short-term major cardiac and cerebrovascular events during the 6 months follow-up period. In conclusion, PMI did not correlate with high on-clopidogrel RPA in elective PCI. The present study suggests that only PCI procedure but not the other factors including high on-clopidogrel RPA might predict PMI after elective PCI.
- © 2012 by American Heart Association, Inc.