title: High platelet reactivity is associated with vascular function in patients after percutaneous coronary intervention receiving clopidogrel.
abstract: BACKGROUND
  In the present study, we evaluated the association of platelet reactivity with vascular function in patients after percutaneous coronary intervention receiving clopidogrel treatment.
  
  
  METHODS
  We enrolled 150 patients with stable CAD receiving clopidogrel regimen (75 mg/d), 1 month after percutaneous coronary intervention. Carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as an index of arterial wave reflections. High on treatment platelet reactivity (HPR) was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU), and the diagnostic cutoff value is 230 PRU. Patients were evaluated prospectively up to 24 months. The primary end point was a composite of death from cardiovascular causes, nonfatal major cardiovascular events and hospitalization for cardiovascular causes.
  
  
  RESULTS
  There was no difference in the basic clinical and demographic characteristics between subjects with HPR and non-HPR. Subjects with high on treatment platelet reactivity and PRU>230 had significantly increased PWV (8.81 ± 2.25 m/s vs. 7.69 ± 1.95 m/s, p = 0.001) and AIx (25.27 ± 8.67% vs. 20.87 ± 10.57%, p = 0.04) compared to subjects with PRU≤230. PWV was also associated with PRU (r = 0.23, p = 0.02). HPR was associated with significantly increased risk of primary end point [HR = 5.38, 95%CI:(1.15, 26.04), p = 0.03].
  
  
  CONCLUSIONS
  Increased platelet reactivity is associated with impaired arterial stiffness in patients after percutaneous coronary intervention receiving clopidogrel treatment, highlighting another clinical factor implicated in individual platelet response to antiplatelet therapy. Moreover, increased platelet reactivity is associated with adverse outcome in these patients.
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece; Department of Biological Chemistry, University of Athens Medical School, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Siasos
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Oikonomou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Marina
authors.initials: M
authors.lastname: Zaromitidou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Kioufis
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Manolis
authors.initials: M
authors.lastname: Vavuranakis
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Maniatis
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Kokkou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papageorgiou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Papaioannou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tourikis
authors.affiliation: Department of Biological Chemistry, University of Athens Medical School, Athens, Greece.
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Papavassiliou
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.affiliation: 1st Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, Greece. Electronic address: drtousoulis@hotmail.com.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
mesh_terms: D001792:Blood Platelets / Q000502:physiology*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011184:Postoperative Period; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Clopidogrel; Coronary artery disease; Platelet reactivity; Vascular function