TY - JOUR
T1 - Association of measured platelet reactivity with changes in P2Y12 receptor inhibitor therapy and outcomes after myocardial infarction
T2 - Insights into routine clinical practice from the TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) study
AU - Bagai, Akshay
AU - Peterson, Eric D.
AU - McCoy, Lisa A.
AU - Effron, Mark B.
AU - Zettler, Marjorie E.
AU - Stone, Gregg W.
AU - Henry, Timothy D.
AU - Cohen, David J.
AU - Schulte, Phillip J.
AU - Anstrom, Kevin J.
AU - Wang, Tracy Y.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - Background Little is known about the use of platelet function testing to guide choice of P2Y12 receptor inhibitor therapy in routine clinical practice. Methods We studied 671 myocardial infarction (MI) patients treated with percutaneous coronary intervention in the TRANSLATE-ACS Registry who had VerifyNow platelet function testing performed while on clopidogrel treatment during their index hospitalization (April 2010–October 2012). Results High platelet reactivity (>208 platelet reactivity units [PRU]) was present in 261 (38.9%) patients. Clopidogrel was switched in-hospital to prasugrel in 80 (30.7%) patients with high platelet reactivity and 18 (4.4%) patients with therapeutic platelet reactivity (≤208 PRU). Among high platelet reactivity patients, switch to prasugrel was associated with lower major adverse cardiovascular events (death, MI, stroke, or unplanned revascularization) at 1 year (10.0% vs 22.7%, P = 02 adjusted odds ratio [OR] 0.39, 95% CI 0.18-0.85, P = 02) and no significant difference in Bleeding Academic Research Consortium type 2 or higher bleeding (23.8% vs 22.1%, P = 77 adjusted OR 0.91, 95% CI 0.48-1.7, P = 77) compared with patients continued on clopidogrel. No significant differences in major adverse cardiovascular event (22.2% vs 12.8%, P = 25 adjusted OR 1.8, 95% CI 0.47-7.3, P = 38) or bleeding (22.2% vs 19.4%, P = 77 adjusted OR 1.3, 95% CI 0.27-6.8, P = 72) were observed among therapeutic platelet reactivity patients between switching and continuation on clopidogrel. Conclusions Only one-third of percutaneous coronary intervention–treated MI patients with high on-clopidogrel platelet reactivity were switched to a more potent P2Y12 receptor inhibitor. Intensification of antiplatelet therapy was associated with lower risk of ischemic events at 1 year among HPR patients.
AB - Background Little is known about the use of platelet function testing to guide choice of P2Y12 receptor inhibitor therapy in routine clinical practice. Methods We studied 671 myocardial infarction (MI) patients treated with percutaneous coronary intervention in the TRANSLATE-ACS Registry who had VerifyNow platelet function testing performed while on clopidogrel treatment during their index hospitalization (April 2010–October 2012). Results High platelet reactivity (>208 platelet reactivity units [PRU]) was present in 261 (38.9%) patients. Clopidogrel was switched in-hospital to prasugrel in 80 (30.7%) patients with high platelet reactivity and 18 (4.4%) patients with therapeutic platelet reactivity (≤208 PRU). Among high platelet reactivity patients, switch to prasugrel was associated with lower major adverse cardiovascular events (death, MI, stroke, or unplanned revascularization) at 1 year (10.0% vs 22.7%, P = 02 adjusted odds ratio [OR] 0.39, 95% CI 0.18-0.85, P = 02) and no significant difference in Bleeding Academic Research Consortium type 2 or higher bleeding (23.8% vs 22.1%, P = 77 adjusted OR 0.91, 95% CI 0.48-1.7, P = 77) compared with patients continued on clopidogrel. No significant differences in major adverse cardiovascular event (22.2% vs 12.8%, P = 25 adjusted OR 1.8, 95% CI 0.47-7.3, P = 38) or bleeding (22.2% vs 19.4%, P = 77 adjusted OR 1.3, 95% CI 0.27-6.8, P = 72) were observed among therapeutic platelet reactivity patients between switching and continuation on clopidogrel. Conclusions Only one-third of percutaneous coronary intervention–treated MI patients with high on-clopidogrel platelet reactivity were switched to a more potent P2Y12 receptor inhibitor. Intensification of antiplatelet therapy was associated with lower risk of ischemic events at 1 year among HPR patients.
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U2 - 10.1016/j.ahj.2017.02.003
DO - 10.1016/j.ahj.2017.02.003
M3 - Article
C2 - 28454802
AN - SCOPUS:85013789060
SN - 0002-8703
VL - 187
SP - 19
EP - 28
JO - American Heart Journal
JF - American Heart Journal
ER -