title: Point-of-care measured platelet inhibition correlates with a reduced risk of an adverse cardiac event after percutaneous coronary intervention: results of the GOLD (AU-Assessing Ultegra) multicenter study.
abstract: BACKGROUND
  The optimal level of platelet inhibition with a glycoprotein (GP) IIb/IIIa antagonist necessary to minimize thrombotic complications in patients undergoing a percutaneous coronary intervention (PCI) is currently unknown.
  
  
  RESULTS
  Five hundred patients undergoing a PCI with the planned use of a GP IIb/IIIa inhibitor had platelet inhibition measured at 10 minutes, 1 hour, 8 hours, and 24 hours after the initiation of therapy with the Ultegra Rapid Platelet Function Assay (Accumetrics). Major adverse cardiac events (MACES: composite of death, myocardial infarction, and urgent target vessel revascularization) were prospectively monitored, and the incidence correlated with the measured level of platelet function inhibition at all time points. One quarter of all patients did not achieve >/=95% inhibition 10 minutes after the bolus and experienced a significantly higher incidence of MACEs (14.4% versus 6.4%, P=0.006). Patients whose platelet function was <70% inhibited at 8 hours after the start of therapy had a MACE rate of 25% versus 8.1% for those >/=70% inhibited (P=0.009). By multivariate analysis, platelet function inhibition >/=95% at 10 minutes after the start of therapy was associated with a significant decrease in the incidence of a MACE (odds ratio 0.46, 95% CI 0.22 to 0.96, P=0.04).
  
  
  CONCLUSIONS
  Substantial variability in the level of platelet function inhibition is achieved with GP IIb/IIIa antagonist therapy among patients undergoing PCI. The level of platelet function inhibition as measured by a point-of-care assay is an independent predictor for the risk of MACEs after PCI.
authors.affiliation: Department of Cardiology, Wilford Hall Medical Center, San Antonio, Texas, USA. steven.steinhubl@59mdw.whmc.af.mil
authors.forename: S R
authors.initials: SR
authors.lastname: Steinhubl
authors.forename: J D
authors.initials: JD
authors.lastname: Talley
authors.forename: G A
authors.initials: GA
authors.lastname: Braden
authors.forename: J E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: P J
authors.initials: PJ
authors.lastname: Casterella
authors.forename: D J
authors.initials: DJ
authors.lastname: Moliterno
authors.forename: F I
authors.initials: FI
authors.lastname: Navetta
authors.forename: P B
authors.initials: PB
authors.lastname: Berger
authors.forename: J J
authors.initials: JJ
authors.lastname: Popma
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: R
authors.initials: R
authors.lastname: Gallo
authors.forename: D C
authors.initials: DC
authors.lastname: Sane
authors.forename: J F
authors.initials: JF
authors.lastname: Saucedo
authors.forename: G
authors.initials: G
authors.lastname: Jia
authors.forename: A M
authors.initials: AM
authors.lastname: Lincoff
authors.forename: P
authors.initials: P
authors.lastname: Theroux
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: P S
authors.initials: PS
authors.lastname: Teirstein
authors.forename: D J
authors.initials: DJ
authors.lastname: Kereiakes
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology; D015331:Cohort Studies; D000077542:Eptifibatide; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D000077466:Tirofiban; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab