The Residual Platelet Aggregation after Deployment of Intracoronary Stent (PREDICT) score.
BACKGROUND
Recent studies suggest a high interindividual variability of response to clopidogrel associated with adverse cardiovascular outcome. Different clinical factors are considered to influence a persistent residual platelet aggregation (RPA) despite conventional antiplatelet therapy.


OBJECTIVE
To investigate clinical factors that affect RPA after 600-mg clopidogrel loading in a large unselected cohort of patients with symptomatic CAD.


METHODS
The study population included a consecutive cohort of 1,092 patients treated with coronary stenting for stable angina and acute coronary syndromes (ACS). Residual platelet activity was assessed by ADP (20 micromol L(-1))-induced platelet aggregation >or= 6 h after LD. Eleven clinical factors were included in the primary analysis.


RESULTS
In multivariate regression analysis increased RPA was significantly influenced by ACS, reduced LV-function, diabetes mellitus, renal failure (creatinine > 1.5 mg dL(-1)), and age > 65 years. In a factor-weighed model the risk for high RPA increased with higher score levels (OR for patients with a score of 1-3, 1.21, 95% CI 0.7-2.1; score 4-6, OR 2.0, 95% CI 1.17-3.5; P = 0.01; score 7-9, OR 3.3, 95% CI 1.8-6.0). During a 30-day follow-up the incidence of major adverse events was higher in patients with RPA in the upper tertile (4.8% vs. 2.5% in the 2nd and 1.5% in the 1st tertile; P < 0.05).


CONCLUSIONS
The PREDICT score provides a good tool to estimate residual platelet activity after clopidogrel LD by easily available patient details. Additionally, we demonstrate its association with short-term outcome. Thus, patients with a high score may benefit from intensified antiplatelet therapy by improved platelet inhibition and risk reduction for thromboischemic events.
Geisler
T
T
Medizinische Klinik III/Cardiology Department, University Hospital Tübingen, Tübingen, Germany.
Grass
D
D
Bigalke
B
B
Stellos
K
K
Drosch
T
T
Dietz
K
K
Herdeg
C
C
Gawaz
M
M
D054058:Acute Coronary Syndrome / Q000097:blood / Q000628:therapy; D000244:Adenosine Diphosphate / Q000494:pharmacology; D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000628:therapy; D000077144:Clopidogrel; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010974:Platelet Aggregation; D010979:Platelet Function Tests; D012044:Regression Analysis; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000244:Adenosine Diphosphate; D000077144:Clopidogrel; D013988:Ticlopidine