title: Combination of P2Y12 reaction unit and percentage of platelet inhibition assessed by VerifyNow P2Y12 assay is a useful predictor of long-term clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
abstract: BACKGROUND
  High on-treatment platelet reactivity is a well-known risk factor for adverse events in patients undergoing percutaneous coronary intervention (PCI). This study was to investigate the value of a novel platelet reactivity-based system, named the COP-INH (COmbination of P2Y12 reaction unit [PRU] and percentage of platelet inhibition [%INH]), assessed by VerifyNow P2Y12 assay, for predicting the long-term ischaemic events in patients with acute coronary syndrome (ACS) undergoing PCI.
  
  
  METHODS
  The COP-INH was calculated on the basis of data obtained at 30days after PCI: patients with both an elevated PRU (≥230) and decreased %INH (<40%) were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively. The primary endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization at 1year follow-up. The relationship between the COP-INH score and primary endpoint was analyzed.
  
  
  RESULTS
  207 patients were enrolled. Baseline characteristics were similar between patients with COP-INH=2 and patients with COP-INH=1 or 0, except for diabetes mellitus (43.8% vs. 21.7%, p=0.015) and previous coronary artery bypass grafting (CABG) (21.9% vs. 6.86%, p=0.007). During the observation period, the incidence of major adverse cardiovascular events (MACE) in patients with COP-INH=2 was significantly higher than patients with COP-INH=1 or 0 (18.8% vs. 4.6%, p=0.007). Multivariate analysis of clinical characteristics and platelet reactivity selected by univariate analysis showed that the COP-INH=2 was an independent predictor of MACE in patients with ACS undergoing PCI (OR 2.745; 95% CI 1.369-9.851; p=0.024), whereas neither PRU≥230 nor %INH<40% was.
  
  
  CONCLUSIONS
  The COP-INH is considered to be a useful predictor of long-term ischaemic events of patients with ACS undergoing PCI.
authors.affiliation: Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jimin
authors.initials: J
authors.lastname: Li
authors.affiliation: State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China; Fudan Center for Genetic Epidemiology, School of Life Sciences, Fudan University, Shanghai, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.affiliation: State Key Laboratory of Genetic Engineering and Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China; Fudan Center for Genetic Epidemiology, School of Life Sciences, Fudan University, Shanghai, China; Fudan Institute of Urology, Huashan Hospital, Fudan University, Shanghai, China; Center for Genomic Translational Medicine and Prevention, School of Public Health, Fudan University, Shanghai, China; NorthShore Research Institute, NorthShore University Health System, Evanston, IL, USA.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Zi
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yian
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xuebo
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. Electronic address: ljm_ly@126.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lai
mesh_terms: D054058:Acute Coronary Syndrome / Q000378:metabolism / Q000601:surgery*; D000368:Aged; D001792:Blood Platelets / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests / Q000379:methods*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D058925:Receptors, Purinergic P2Y12 / Q000378:metabolism*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12
keywords: Acute coronary syndrome; Clopidogrel; Platelet reactivity; Stent