Impact of Platelet Reactivity to Adenosine Diphosphate Before Implantation of Drug-Eluting Stents on Subsequent Adverse Cardiac Events in Patients With Stable Angina

Motoda Chikaaki

Ueda Hironori

Hayashi Yasuhiko

Toyofuku Mamoru

Okimoto Tomokazu

Otsuka Masaya

Tamekiyo Hiromichi

Kawase Tomoharu

Kihara Yasuki

Circulation Journal

Background: Diverse pharmacological effects of anti-platelet thienopyridines due to individual differences in metabolism have been reported. However, an association between on-treatment platelet reactivity and adverse ischemic events after drug-eluting stent (DES) implantation in Japanese patients has not been fully elucidated.

Methods and Results: A total of 450 consecutive patients on dual anti-platelet therapy (aspirin and ticlopidine) with stable angina who underwent DES implantation were enrolled. Adenosine diphosphate (ADP)-induced platelet aggregation was measured before DES implantation using the screen filtration pressure method. The ADP concentration necessary for 50% aggregation was designated as the platelet aggregation threshold index (PATI). A composite primary endpoint of cardiac death, myocardial infarction, target lesion revascularization (TLR), and stent thrombosis occurring within 1 year after stenting, was evaluated. A PATI value <4.8 mu mol/L was defined as high on-treatment reactivity to ADP. The composite primary endpoint occurred in 55 patients (12.2%) in the 1-year-period after DES implantation, and the prevalence was 19.0% and 5.1% in groups with high and low on-treatment reactivity to ADP, respectively, showing a significantly higher prevalence in the high reactivity group (P<0.001). The main event was TLR (18.1% vs. 5.1%, P<0.001).

Conclusions: These data suggested that high on-treatment platelet reactivity to ADP and subsequent occurrence of adverse ischemic events (particularly TLR) were correlated in patients with stable angina who underwent DES implantation. (Circ J 2012; 76: 641-649)

Anti-platelet therapy

Drug-eluting stent

Percutaneous coronary intervention

Platelet reactivity to ADP

Revascularization

Medical sciences [ 490 ]

eng

Japanese Circulation Society

(c) All rights are reserved to the Japanese Circulation Society.

[ISSN] 1346-9843

[DOI] 10.1253/circj.CJ-11-0435

[NCID] AA11591968

[DOI] http://dx.doi.org/10.1253/circj.CJ-11-0435