Vasodilator-stimulated phosphoprotein phosphorylation analysis prior to percutaneous coronary intervention for exclusion of postprocedural major adverse cardiovascular events.
BACKGROUND
Despite dual antiplatelet therapy, the rate of major adverse cardiovascular events (MACE) after percutaneous coronary angioplasty remains high. Studies have shown interindividual variations in response to clopidogrel. Furthermore, there is an apparent link between clinical outcomes and clopidogrel resistance.


OBJECTIVE
To investigate the value of platelet reactivity index (PRI), assessed by vasodilator-stimulated phosphoprotein (VASP) phosphorylation analysis, for predicting MACE after percutaneous coronary intervention (PCI) with stent implantation.


METHODS
A prospective monocentric study was performed on 144 patients undergoing PCI. PR was evaluated by VASP phosphorylation analysis 24 h after they received a 300-mg loading dose of clopidogrel. MACE were recorded during a 6-month follow-up. Patients were divided into quintiles according to PRI, as assessed by VASP analysis. The receiver operating characteristic (ROC) curve served to determine the optimal cut-off value of VASP analysis to detect MACE.


RESULTS
Of the 144 patients, 34% had stable angina pectoris, 40% silent ischemia, and 26% low-risk non-ST-segment elevation acute coronary syndrome. During the follow-up, 21 MACE were observed. Patients in quintile 1 of VASP analysis had a significantly lower risk of MACE as compared with those among the four higher quintiles (0 vs. 21, P < 0.01). ROC curve analysis of VASP showed an optimal cut-off value of 50% PR to exclude MACE. The negative predictive value of the test was 100%.


CONCLUSIONS
VASP phosphorylation analysis can evaluate the individual response to clopidogrel loading dose prior to PCI and predict postprocedural MACE.
Bonello
L
L
Département de Cardiologie, Hôpital Universitaire Nord, Chemin des Bourrely, Marseille, France.
Paganelli
F
F
Arpin-Bornet
M
M
Auquier
P
P
Sampol
J
J
Dignat-George
F
F
Barragan
P
P
Camoin-Jau
L
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001792:Blood Platelets / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000517:prevention & control / Q000628:therapy*; D015815:Cell Adhesion Molecules / Q000096:biosynthesis* / Q000737:chemistry; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D008297:Male; D008840:Microfilament Proteins / Q000096:biosynthesis* / Q000737:chemistry; D008875:Middle Aged; D010750:Phosphoproteins / Q000096:biosynthesis* / Q000737:chemistry; D010766:Phosphorylation; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology; D014665:Vasodilator Agents / Q000494:pharmacology*; D000098662:Vasodilator-Stimulated Phosphoprotein
D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; D010750:Phosphoproteins; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D000098662:Vasodilator-Stimulated Phosphoprotein; D000077144:Clopidogrel; D013988:Ticlopidine