Abstract 14208: Impact of Higher On-treatment Platelet Reactivity on Peri-procedural Myocardial Infarction, 1-month and 1-year Clinical Outcomes After Percutaneous Coronary Intervention in a Veteran Population
Introduction: Various studies have investigated the association of higher on-treatment platelet reactivity with cardiovascular events after percutaneous coronary intervention (PCI). Results thus far have been variable.
Hypothesis: Higher on-treatment platelet reactivity, as measured by the VerifyNow point-of-care platelet function assay, is associated with major adverse cardiovascular events (MACE) in veterans undergoing PCI.
Methods: Veterans who underwent PCI from January 2009 to October 2011 were included in this observational, single center, retrospective study. All patients received loading and maintenance doses of dual antiplatelet therapy with aspirin and clopidogrel. All patients had P2Y12 platelet reactivity units (PRU) measured the day following PCI using the VerifyNow platelet function assay. The primary endpoint was occurrence of MACE including cardiac death, non-fatal myocardial infarction, stent thrombosis and target vessel revascularization (TVR) at 1 month and 1 year. PRU values were also correlated to peri-procedural myocardial infarction (MI), coronary artery disease (CAD) risk factors and the use of proton pump inhibitors (PPI).
Results: A total of 251 patients were included in this review. There was no correlation between a higher PRU and peri-procedural MI as measured by post-procedure troponin-I increase (p=0.51). Table 1 lists the correlation between higher PRUs and 1-month and 1-year MACE. Higher PRUs were associated with TVR at 1 year. The correlation between CAD risk factors and higher PRUs is shown in table 2. Patients on PPI had significantly higher PRUs (p=0.0025) when compared with those not on PPI therapy.
Conclusions: Higher on-treatment platelet reactivity does not correlate to peri-procedural MI or to MACE at one month. There is a positive correlation with TVR at one year. Patients with diabetes mellitus, high triglycerides, chronic kidney disease and patients on PPI have significantly higher PRUs.
- © 2013 by American Heart Association, Inc.