Identification of platelet hyper-reactivity measured with a portable device immediately after percutaneous coronary intervention predicts in stent thrombosis.
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.
Jacopo
Gianetti
G
Laboratory of Atherosclerosis and Thrombosis, CNR Institute of Clinical Physiology, G. Pasquinucci Hospital, Massa, Italy.
Elisabetta
Volpi
V
Silverio
Sbrana
S
Massimiliano
Mariani
M
Sergio
Berti
B
Grazia
Andreassi Maria
AM
Philippe
Collet Jean
CJ
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*
D003094:Collagen; D004837:Epinephrine