title: Different prognostic significance of high on-treatment platelet reactivity as assessed by the VerifyNow P2Y12 assay after coronary stenting in patients with and without acute myocardial infarction.
abstract: OBJECTIVE
  This study compared the prognostic role of high on-treatment platelet reactivity (HTPR) in predicting thrombotic events in a Korean population undergoing percutaneous coronary intervention (PCI) in the acute myocardial infarction (AMI) and non-AMI setting.
  
  
  BACKGROUND
  The prognostic significance and optimal cutoff of HTPR might differ according to a given clinical condition, such as AMI and ethnicity.
  
  
  METHODS
  On-treatment platelet reactivity was measured with a VerifyNow P2Y12 assay (Accumetrics, San Diego, California) in 1,226 patients (824 men; age 65 ± 10 years), including 413 AMI cases, 12 to 24 h after PCI between March 2008 and March 2010. The prevalence of cardiovascular (CV) events defined as a composite of death from CV causes, nonfatal myocardial infarction, or stent thrombosis at 1-year follow-up were compared according to HTPR between patients with and without AMI.
  
  
  RESULTS
  The optimal cutoff for HTPR was 272 IU of the P2Y(12) reaction unit (PRU) (area under the curve: 0.708; 95% confidence interval [CI]: 0.607 to 0.809, p = 0.03), which was the upper-tertile threshold. Among AMI patients, 1-year CV events occurred more frequently in patients with versus without HTPR (n = 14 [8.8%] vs. n = 1 [0.4%], p < 0.001), whereas there was no difference in the composite endpoint on the basis of HTPR in patients without AMI (n = 7 [2.8%] vs. n = 8 [1.4%], p = 0.193).
  
  
  CONCLUSIONS
  Increased residual platelet reactivity is related to post-discharge CV events in subjects with AMI, whereas the prognostic significance of HTPR seems to be attenuated in patients with stable coronary disease after PCI.
authors.affiliation: Division of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, South Korea.
authors.forename: Sung Gyun
authors.initials: SG
authors.lastname: Ahn
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Jin-Ha
authors.initials: JH
authors.lastname: Yoon
authors.forename: Woo Taek
authors.initials: WT
authors.lastname: Kim
authors.forename: Jun-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Youn
authors.forename: Min-Soo
authors.initials: MS
authors.lastname: Ahn
authors.forename: Jang-Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Byung-Su
authors.initials: BS
authors.lastname: Yoo
authors.forename: Junghan
authors.initials: J
authors.lastname: Yoon
authors.forename: Kyung-Hoon
authors.initials: KH
authors.lastname: Choe
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects*; D012008:Recurrence; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12