title: Platelet activation predicts recurrent ischemic events after percutaneous coronary angioplasty: a 6 months prospective study.
abstract: BACKGROUND
  An increasing amount of evidence indicates that platelet reactivity, despite a standard anti-thrombotic therapy, is a potential risk factor for recurrent myocardial ischemia in patients with coronary artery disease. We now hypothesize that this condition, measured by collagen-epinephrine (CEPI) or collagen-ADP (CADP) closure times (CT) by Platelet Function Analyzer (PFA-100), may predict the recurrence of coronary events after percutaneous coronary intervention (PCI).
  
  
  METHODS
  CEPI and CADP-CT were measured 30+/-8 h after PCI in 175 consecutive patients admitted with a diagnosis of stable angina (n=94) or acute coronary syndromes (n=81) and prospectively followed up for a mean period of 6 months. We stratified the patients in accordance to both the CEPI-CT (<or> 190 s), reflecting the intensity of cycloxygenase inhibition by aspirin and the distribution into quartiles for CADP-CT.
  
  
  RESULTS
  CEPI-CT<190 s as well as CADP-CT<82 s were associated with a higher rate of clinical recurrence (hazard ratio 8.5, p<0.001 and 22.9, p<0.001, respectively). Multivariate analysis after adjustment for other risk factors confirmed that the lowest CADP-CT quartile significantly correlates with the risk of recurrent coronary events (hazard ratio 36.5, p<0.01), as well as CEPI-CT<190 s (hazard ratio 6.7, p=0.01).
  
  
  CONCLUSIONS
  An enhanced platelet function after PCI when measured under high shear rates by PFA-100 is an independent predictor of a worst clinical outcome, even during a short term follow-up and may help in patients risk stratification.
authors.affiliation: Laboratory of Atherosclerosis and Thrombosis, CNR Institute of Clinical Physiology, G Pasquinucci Hospital, Massa, Italy. gianetti@ifc.pi.cnr.it
authors.forename: Jacopo
authors.initials: J
authors.lastname: Gianetti
authors.forename: Maria Serena
authors.initials: MS
authors.lastname: Parri
authors.forename: Silverio
authors.initials: S
authors.lastname: Sbrana
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Paoli
authors.forename: Stefano
authors.initials: S
authors.lastname: Maffei
authors.forename: Umberto
authors.initials: U
authors.lastname: Paradossi
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
authors.forename: Aldo
authors.initials: A
authors.lastname: Clerico
authors.forename: Andrea
authors.initials: A
authors.lastname: Biagini
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003094:Collagen / Q000494:pharmacology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015539:Platelet Activation / Q000187:drug effects; D010974:Platelet Aggregation / Q000187:drug effects; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
chemical_list: D000244:Adenosine Diphosphate; D003094:Collagen; D004837:Epinephrine