title: Evaluation of clinical risk factors to predict high on-treatment platelet reactivity and outcome in patients with stable coronary artery disease (PREDICT-STABLE).
abstract: OBJECTIVE
  This study was designed to identify the multivariate effect of clinical risk factors on high on-treatment platelet reactivity (HPR) and 12 months major adverse events (MACE) under treatment with aspirin and clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI).
  
  
  METHODS
  739 consecutive patients with stable coronary artery disease (CAD) undergoing PCI were recruited. On-treatment platelet aggregation was tested by light transmittance aggregometry. Clinical risk factors and MACE during one-year follow-up were recorded. An independent population of 591 patients served as validation cohort.
  
  
  RESULTS
  Degree of on-treatment platelet aggregation was influenced by different clinical risk factors. In multivariate regression analysis older age, diabetes mellitus, elevated BMI, renal function and left ventricular ejection fraction were independent predictors of HPR. After weighing these variables according to their estimates in multivariate regression model, we developed a score to predict HPR in stable CAD patients undergoing elective PCI (PREDICT-STABLE Score, ranging 0-9). Patients with a high score were significantly more likely to develop MACE within one year of follow-up, 3.4% (score 0-3), 6.3% (score 4-6) and 10.3% (score 7-9); odds ratio 3.23, P=0.02 for score 7-9 vs. 0-3. This association was confirmed in the validation cohort.
  
  
  CONCLUSIONS
  Variability of on-treatment platelet function and associated outcome is mainly influenced by clinical risk variables. Identification of high risk patients (e.g. with high PREDICT-STABLE score) might help to identify risk groups that benefit from more intensified antiplatelet regimen. Additional clinical risk factor assessment rather than isolated platelet function-guided approaches should be investigated in future to evaluate personalized antiplatelet therapy in stable CAD-patients.
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Michal
authors: M
authors: Droppa
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Dimitri
authors: D
authors: Tschernow
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Karin A L
authors: KA
authors: Müller
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Elli
authors: E
authors: Tavlaki
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Athanasios
authors: A
authors: Karathanos
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Fabian
authors: F
authors: Stimpfle
authors: Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany.
authors: Elke
authors: E
authors: Schaeffeler
authors: Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart, Germany; Department of Clinical Pharmacology, University Hospital of Tübingen, Tübingen, Germany.
authors: Matthias
authors: M
authors: Schwab
authors: Laboratory Medicine Institute, Medical Center of the University of Munich, Munich, Germany.
authors: Alexander
authors: A
authors: Tolios
authors: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors: Jolanta M
authors: JM
authors: Siller-Matula
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Meinrad
authors: M
authors: Gawaz
authors: Department of Cardiology and Cardiovascular Medicine, University Hospital of Tübingen, Tübingen, Germany.
authors: Tobias
authors: T
authors: Geisler
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000097:blood / Q000601:surgery*; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D011183:Postoperative Complications / Q000453:epidemiology*; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000453:epidemiology* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors