title: Identification of platelet hyper-reactivity measured with a portable device immediately after percutaneous coronary intervention predicts in stent thrombosis.
abstract: BACKGROUND
  Platelet hyper-reactivity, despite a standard anti-thrombotic therapy, is a recognized risk factor for recurrent myocardial ischemia and in-stent thrombosis following PCI. We have investigated whether this detrimental condition, measured by collagen-epinephrine closure times (CEPI-CT) with the Platelet Function Analyzer (PFA-100) device could predict IST defined as the composite of cardiovascular death or myocardial infarction.
  
  
  METHODS
  CEPI-CT was measured in 256 consecutive patients with stable angina (n=103) or ACS (n=153) 30+/-8 h after PCI (T 0) and 1 month later (T1). All patients were followed up for a mean period of 9 months. Platelet hyperactivity was defined as a CEPI-CT<190 s.
  
  
  RESULTS
  Baseline CEPI-CT<190 s was associated with a higher rate of death or MI (LogRank chi2=4.23, p=0.039) as compared with CEPI-CT>190 s (4.6% vs. 0.7%). Multivariable analysis after adjustment for other risk factors confirmed that baseline CEPI-CT<190 s was an independent correlate for death or MI (Hazard ratio 6.981, p=0.008). At T1 there was a significant prolongation of CEPI-CT (p=0.03) from 208+/-64 s to 240+/-59 s but T1 did not predict any event.
  
  
  CONCLUSIONS
  A CEPI-CT<190 s measured within the first 24 h following PCI predicts IST defined as the occurrence of death or MI.
authors.affiliation: Laboratory of Atherosclerosis and Thrombosis, CNR Institute of Clinical Physiology, G. Pasquinucci Hospital, Massa, Italy.
authors.forename: Gianetti
authors.initials: G
authors.lastname: Jacopo
authors.forename: Volpi
authors.initials: V
authors.lastname: Elisabetta
authors.forename: Sbrana
authors.initials: S
authors.lastname: Silverio
authors.forename: Mariani
authors.initials: M
authors.lastname: Massimiliano
authors.forename: Berti
authors.initials: B
authors.lastname: Sergio
authors.forename: Andreassi Maria
authors.initials: AM
authors.lastname: Grazia
authors.forename: Collet Jean
authors.initials: CJ
authors.lastname: Philippe
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001791:Blood Platelet Disorders / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D003094:Collagen / Q000494:pharmacology; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology; D015539:Platelet Activation / Q000187:drug effects; D010979:Platelet Function Tests / Q000295:instrumentation* / Q000379:methods; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000097:blood* / Q000209:etiology*
chemical_list: D003094:Collagen; D004837:Epinephrine