title: Impact of platelet reactivity to adenosine diphosphate before implantation of drug-eluting stents on subsequent adverse cardiac events in patients with stable angina.
abstract: BACKGROUND
  Diverse pharmacological effects of anti-platelet thienopyridines due to individual differences in metabolism have been reported. However, an association between on-treatment platelet reactivity and adverse ischemic events after drug-eluting stent (DES) implantation in Japanese patients has not been fully elucidated.
  
  
  RESULTS
  A total of 450 consecutive patients on dual anti-platelet therapy (aspirin and ticlopidine) with stable angina who underwent DES implantation were enrolled. Adenosine diphosphate (ADP)-induced platelet aggregation was measured before DES implantation using the screen filtration pressure method. The ADP concentration necessary for 50% aggregation was designated as the platelet aggregation threshold index (PATI). A composite primary endpoint of cardiac death, myocardial infarction, target lesion revascularization (TLR), and stent thrombosis occurring within 1 year after stenting, was evaluated. A PATI value <4.8 µmol/L was defined as high on-treatment reactivity to ADP. The composite primary endpoint occurred in 55 patients (12.2%) in the 1-year-period after DES implantation, and the prevalence was 19.0% and 5.1% in groups with high and low on-treatment reactivity to ADP, respectively, showing a significantly higher prevalence in the high reactivity group (P<0.001). The main event was TLR (18.1% vs. 5.1%, P<0.001).
  
  
  CONCLUSIONS
  These data suggested that high on-treatment platelet reactivity to ADP and subsequent occurrence of adverse ischemic events (particularly TLR) were correlated in patients with stable angina who underwent DES implantation.
authors.affiliation: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors.forename: Chikaaki
authors.initials: C
authors.lastname: Motoda
authors.forename: Hironori
authors.initials: H
authors.lastname: Ueda
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Okimoto
authors.forename: Masaya
authors.initials: M
authors.lastname: Otsuka
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Tamekiyo
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Kawase
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology*; D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000097:blood / Q000150:complications*; D001241:Aspirin / Q000627:therapeutic use; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology*; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013988:Ticlopidine / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000244:Adenosine Diphosphate; D013988:Ticlopidine; D001241:Aspirin