title: Value of platelet reactivity in predicting response to treatment and clinical outcome in patients undergoing primary coronary intervention: insights into the STRATEGY Study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the value of platelet reactivity (PR) in predicting the response to treatment and outcome in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention assisted by glycoprotein (GP) IIb/IIIa inhibition.
  
  
  BACKGROUND
  There is limited prognostic information on the role of spontaneous or drug-modulated PR in STEMI patients.
  
  
  METHODS
  The PR was measured with Platelet Function Analyzer (PFA)-100 and light transmission aggregometry (LTA) using adenosine diphosphate as agonist in 70 consecutive STEMI patients at entry (PR-T0), 10 min after GP IIb/IIIa bolus (PR-T1), and discharge (PR-T2) and in 30 stable angina (SA) patients (PR-SA). Complete platelet inhibition (CPI) was based on closure time >300 s by PFA-100 and percentage inhibition of platelet aggregation >95% by LTA. Clinical, electrocardiographic, and angiographic responses to treatment during 1-year follow-up were collected.
  
  
  RESULTS
  According to both techniques, PR-T0 was higher than: 1) PR-T2 and PR-SA; 2) in those without CPI at T1; and 3) in patients with final Thrombolysis In Myocardial Infarction (TIMI) flow grade <3. The PR-T0 assessed with PFA-100 correlated with: 1) corrected TIMI frame count (r = -0.6, p < 0.001); 2) ST-segment resolution (r = 45, p < 0.001); and 3) creatine kinase-MB (r = -0.47, p < 0.001). At 1 year, patients with high PR-T0 showed an adjusted 5- to 11-fold increase in the risk of death, reinfarction, and target vessel revascularization (hazard ratio [HR] 11, 95% confidence interval [CI] 1.5 to 78 [p = 0.02] in PFA-100; HR 5.2, 95% CI 1.1 to 23 [p = 0.03] in LTA).
  
  
  CONCLUSIONS
  The PR at entry affects response to GP IIb/IIIa inhibition, mechanical treatment, and long-term outcome in STEMI patients undergoing primary intervention.
authors.affiliation: Department of Cardiology, University of Ferrara, Ferrara, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Donato
authors.initials: D
authors.lastname: Gemmati
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Percoco
authors.forename: Silvia
authors.initials: S
authors.lastname: Tognazzo
authors.forename: Giordano
authors.initials: G
authors.lastname: Cicchitelli
authors.forename: Linda
authors.initials: L
authors.lastname: Catozzi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Malagutti
authors.forename: Maurizio
authors.initials: M
authors.lastname: Anselmi
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Scapoli
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001792:Blood Platelets; D017023:Coronary Angiography; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D010974:Platelet Aggregation; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D013997:Time Factors; D000077466:Tirofiban; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D014443:Tyrosine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D019210:Troponin I; D014443:Tyrosine; D052279:Creatine Kinase, MB Form; D000077466:Tirofiban; D000077284:Abciximab