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Lower Platelet Reactivity Is Associated with Presentation of Unstable Coronary Artery Disease.

ABSTRACT: In patients with acute coronary syndrome, high platelet reactivity (PR) is associated with an increased risk of secondary thrombotic events. However, in patients undergoing elective percutaneous coronary intervention (PCI), no association between high PR and outcome has been demonstrated. At present, the relation of PR and clinical symptoms is unknown. To examine the association of PR with clinical indication for diagnostic angiography (stable or unstable coronary artery disease [CAD]), taking into account the influence of P2Y12 inhibitors. A platelet function score (PFS) was determined in 195 patients by quantifying fibrinogen binding and P-selectin expression with flow cytometry. We evaluated the PFS with clinical presentation of stable or unstable CAD, angiographic severity of CAD, and the incidence of cardiovascular events during 2 years of follow-up. All data were analyzed stratified by P2Y12 inhibitor use (long-term and preprocedural versus none). Surprisingly, among non-P2Y12 inhibitor users, the PFS was lower in patients with unstable CAD compared with stable CAD (5.6?±?1.8 vs. 7.4?±?1.6; p?=?0.001). Angiographic CAD severity showed no relation with PFS. The SYNTAX score tended to be inversely related with PFS: low PFS, 13.2 (IQR, 11.9-19.1); median PFS, 10.0 (IQR, 5.0-14.0); and high PFS, 8.0 (IQR, 5.0-13.0), without significance (p?=?0.304). Patients with low PFSs required more re-PCIs than those with median and high PFSs (11.1 vs. 4.7 vs. 0.0%, p?=?0.004). This association was modified for patients using P2Y12 inhibitors. Among patients without P2Y12 inhibitors undergoing coronary angiography, presentation of unstable CAD is independently associated with lower PR.

SUBMITTER: Leunissen TC

PROVIDER: S-EPMC5114132 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature

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Lower Platelet Reactivity Is Associated with Presentation of Unstable Coronary Artery Disease.

Leunissen Tesse C TC Gijsberts Crystel M CM Wisman Peter Paul PP Huisman Albert A Berg Maarten Ten MT Asselbergs Folkert W FW Hoefer Imo E IE Pasterkamp Gerard G Moll Frans L FL de Borst Gert Jan GJ Roest Mark M

The International journal of angiology : official publication of the International College of Angiology, Inc 20161024 4

In patients with acute coronary syndrome, high platelet reactivity (PR) is associated with an increased risk of secondary thrombotic events. However, in patients undergoing elective percutaneous coronary intervention (PCI), no association between high PR and outcome has been demonstrated. At present, the relation of PR and clinical symptoms is unknown. To examine the association of PR with clinical indication for diagnostic angiography (stable or unstable coronary artery disease [CAD]), taking i ...[more]

PMID: 27867285

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Project description:Background:The mechanisms behind residual platelet reactivity (RPR) despite aspirin treatment are not established. It has been shown that coronary artery disease (CAD) patients with high on-aspirin RPR have elevated levels of von Willebrand factor (vWF). ADAMTS13 is a metalloprotease cleaving ultra large vWF multimers into less active fragments.Our aim was to investigate whether ADAMTS13 and vWF/ADAMTS13 ratio were associated with high RPR, and further with clinical endpoints after 2 years. Methods:Stable aspirin-treated CAD patients (n?=?999) from the ASCET trial. RPR was assessed by PFA-100. ADAMTS13 antigen and activity were analysed using chromogenic assays. Endpoints were a composite of acute myocardial infarction, stroke and death. Results:The number of patients with high RPR was 258 (25.8%). Their serum thromboxane B2 (TxB2) levels were low, indicating inhibition of COX-1. They had significantly lower levels of ADAMTS13 antigen compared to patients with low RPR (517 vs 544 ng/mL, p?=?0.001) and significantly lower ADAMTS13 activity (0.99 vs 1.04 IU/mL, p?=?0.020). The differences were more pronounced when relating RPR to ratios of vWF/ADAMTS13 antigen and vWF/ADAMTS13 activity (p?<?0.001, both). We found an inverse correlation between vWF and ADAMTS13 antigen (r?=?-0.14, p?<?0.001) and ADAMTS13 activity (r?=?-0.11, p?<?0.001). No correlations between TxB2 and ADAMTS13 antigen or activity, were observed, implying that ADAMTS13 is not involved in TxB2 production. Patients who experienced endpoints (n?=?73) had higher vWF level (113 vs 105%, p?=?0.032) and vWF/ADAMTS13 antigen ratio (0.23 vs 0.20, p?=?0.012) compared to patients without. When dichotomizing vWF/ADAMTS13 antigen at median level we observed that patients above median had higher risk for suffering endpoints, with an adjusted OR of 1.86 (95% CI 1.45, 2.82). Conclusion:These results indicate that ADAMTS13 is of importance for RPR, and that it in combination with vWF also is associated with clinical endpoints in stable CAD patients on aspirin. Trial registration:Clinicaltrials.gov NCT00222261. Registered 13.09.2005. Retrospectively registered.

Dataset Information

Lower Platelet Reactivity Is Associated with Presentation of Unstable Coronary Artery Disease.

Publications

Lower Platelet Reactivity Is Associated with Presentation of Unstable Coronary Artery Disease.

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