title: ADP-induced platelet aggregation and platelet reactivity index VASP are good predictive markers for clinical outcomes in non-ST elevation acute coronary syndrome.
abstract: Clopidogrel responsiveness has been proposed to be involved in recurrent ischemic events after stenting for non-ST elevation acute coronary syndromes (NSTE ACS). However, its biological definition is not consensual. We assess the value of ADP-induced platelet aggregation (ADP-Ag) and platelet reactivity index VASP (PRI VASP) in predicting recurrent ischemic events in patients with NSTE ACS undergoing percutaneous coronary intervention (PCI). We studied 195 consecutive NSTE ACS patients undergoing PCI after a 600 mg loading dose of clopidogrel. ADP-Ag and PRI VASP were analysed. The primary end-point was recurrent ischemic events within 30 days of PCI. It occurred in 14 patients (7%). Construction of ROC curves to examine the value of predictive models showed that sensitivity and specificity for primary endpoint were 79% and 76%, respectively, for a maximal intensity of ADP-Ag >or=70%, 93% and 50% for PRIVASP > 53%. The positive and negative predictive values were 21% and 98%, respectively, for ADP-Ag >or=70%, 12% and 99% for PRIVASP > 53%. In patients with NSTE ACS undergoing PCI, ADP-Ag and PRI VASP identify low responders to clopidogrel with an increased risk of recurrent ischemic events with respective cut-off values of 70% and 53%.
authors.affiliation: INSERM, UMR 626, Faculté de Médecine CHU Timone, Marseille, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Frere
authors.forename: Thomas
authors.initials: T
authors.lastname: Cuisset
authors.forename: Jacques
authors.initials: J
authors.lastname: Quilici
authors.forename: Laurence
authors.initials: L
authors.lastname: Camoin
authors.forename: Joseph
authors.initials: J
authors.lastname: Carvajal
authors.forename: Pierre Emmanuel
authors.initials: PE
authors.lastname: Morange
authors.forename: Marc
authors.initials: M
authors.lastname: Lambert
authors.forename: Irène
authors.initials: I
authors.lastname: Juhan-Vague
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bonnet
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Alessi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000235:genetics*; D000208:Acute Disease; D000244:Adenosine Diphosphate / Q000378:metabolism*; D000368:Aged; D001792:Blood Platelets / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000378:metabolism*; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D007511:Ischemia / Q000378:metabolism; D008297:Male; D008840:Microfilament Proteins / Q000378:metabolism*; D008875:Middle Aged; D010750:Phosphoproteins / Q000378:metabolism*; D010766:Phosphorylation; D010974:Platelet Aggregation; D012372:ROC Curve; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000494:pharmacology; D016896:Treatment Outcome; D000098662:Vasodilator-Stimulated Phosphoprotein
chemical_list: D015815:Cell Adhesion Molecules; D008840:Microfilament Proteins; D010750:Phosphoproteins; D000098662:Vasodilator-Stimulated Phosphoprotein; D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine