title: Antiplatelet drug response status does not predict recurrent ischemic events in stable cardiovascular patients: results of the Antiplatelet Drug Resistances and Ischemic Events study.
abstract: BACKGROUND
  The biological response to antiplatelet drugs has repeatedly been shown to predict the recurrence of major adverse cardiovascular events (MACEs). However, most studies involved coronary artery disease patients with recent vessel injury shortly after the initiation of antiplatelet therapy. Data on stable cardiovascular patients are scarce, and the added predictive value of specific assays (the vasodilator phosphoprotein assay for the clopidogrel response and serum thromboxane B2 for the aspirin response) and aggregation-based assays relative to common predictors has rarely been addressed.
  
  
  RESULTS
  Stable cardiovascular outpatients participating in the Antiplatelet Drug Resistances and Ischemic Events (ADRIE) study (n=771) were tested twice, at 2 separate visits, with specific and aggregation-based assays. Follow-up lasted 3 years, and <1% of patients were lost to follow-up. MACEs were adjudicated by an independent committee. Multivariate survival analyses included relevant variables identified in univariate analysis and platelet function test results. The C-index was used to express the prognostic value of various multivariate models. MACEs, the primary end point, occurred in 16% of patients. Hypertension, smoking, older age, and elevated low-density lipoprotein cholesterol were predictive of MACE recurrence, with a C-index of 0.63 (P<0.001). Neither the specific nor the aggregation-based assays added significant predictive value for the primary end point.
  
  
  CONCLUSIONS
  Biological antiplatelet drug responsiveness, measured with specific or aggregation-based assays, has no incremental predictive value over common cardiovascular risk factors for MACE recurrence in stable cardiovascular outpatients. These results do not support platelet function testing for MACE risk evaluation in stable cardiovascular patients.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00501423.
authors.affiliation: Division of General Internal Medicine, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Reny
authors.forename: Philippe
authors.initials: P
authors.lastname: Berdagué
authors.forename: Antoine
authors.initials: A
authors.lastname: Poncet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Barazer
authors.forename: Séverine
authors.initials: S
authors.lastname: Nolli
authors.forename: Pascale
authors.initials: P
authors.lastname: Fabbro-Peray
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Schved
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
authors.forename: François
authors.initials: F
authors.lastname: Mach
authors.forename: Philippe
authors.initials: P
authors.lastname: de Moerloose
authors.forename: Pierre
authors.initials: P
authors.lastname: Fontana
mesh_terms: D000368:Aged; D018432:Drug Resistance, Multiple / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000188:drug therapy* / Q000453:epidemiology; D010974:Platelet Aggregation / Q000187:drug effects / Q000502:physiology; D010975:Platelet Aggregation Inhibitors / Q000097:blood / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012008:Recurrence; D016037:Single-Blind Method; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors