Platelet reactivity characterized prospectively: a determinant of outcome 90 days after percutaneous coronary intervention.
BACKGROUND
Platelet activation is pivotal in the pathogenesis of complications after percutaneous coronary interventions (PCI). We previously reported substantial interindividual variability in activation of glycoprotein (GP) IIb/IIIa in response to a low concentration of ADP. We assessed GP IIb/IIIa activation prospectively to determine whether this could differentiate patients at low risk from those at high risk for complications early and late after PCI. Methods and Results-- A total of 112 patients undergoing PCI were studied. Platelet reactivity was determined with the use of flow cytometry. Patients were classified into high and low platelet reactivity groups on the basis of extent of activation of GP IIb/IIIa in response to 0.2 micromol/L ADP. The median value was used for differentiation. The incidence during 90-day follow-up interval of a composite end point (myocardial infarction, urgent revascularization, or repeat revascularization) was determined in each group. Follow up was completed in all 112 patients. The 2 groups were similar with respect to diverse clinical characteristics. Nevertheless, the incidence of the composite end point occurred in 26.8% of the high and 7.1% in the low platelet reactivity group (P=0.01). The difference in the composite end point was most striking during the 30- to 90-day interval after PCI (16.7% versus 1.9%; P=0.02). Repeat revascularization was more frequent in those with increased platelet reactivity (17.9% versus with 3.6%, P=0.029).


CONCLUSIONS
Prospective assessment of platelet GP IIb/IIIa activation permits stratification of patients into low- and high-risk groups with respect to adverse events after PCI.
Kabbani
S S
SS
Department of Medicine, The University of Vermont College of Medicine, Burlington, VT, USA. samerk@pol.net
Watkins
M W
MW
Ashikaga
T
T
Terrien
E F
EF
Holoch
P A
PA
Sobel
B E
BE
Schneider
D J
DJ
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D003327:Coronary Disease / Q000378:metabolism* / Q000628:therapy*; D023381:Endpoint Determination; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015539:Platelet Activation; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000378:metabolism*; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D018570:Risk Assessment; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex