title: Lower Platelet Reactivity Is Associated with Presentation of Unstable Coronary Artery Disease.
abstract: In patients with acute coronary syndrome, high platelet reactivity (PR) is associated with an increased risk of secondary thrombotic events. However, in patients undergoing elective percutaneous coronary intervention (PCI), no association between high PR and outcome has been demonstrated. At present, the relation of PR and clinical symptoms is unknown. To examine the association of PR with clinical indication for diagnostic angiography (stable or unstable coronary artery disease [CAD]), taking into account the influence of P2Y12inhibitors. A platelet function score (PFS) was determined in 195 patients by quantifying fibrinogen binding and P-selectin expression with flow cytometry. We evaluated the PFS with clinical presentation of stable or unstable CAD, angiographic severity of CAD, and the incidence of cardiovascular events during 2 years of follow-up. All data were analyzed stratified by P2Y12inhibitor use (long-term and preprocedural versus none). Surprisingly, among non-P2Y12inhibitor users, the PFS was lower in patients with unstable CAD compared with stable CAD (5.6 ± 1.8 vs. 7.4 ± 1.6;p= 0.001). Angiographic CAD severity showed no relation with PFS. The SYNTAX score tended to be inversely related with PFS: low PFS, 13.2 (IQR, 11.9-19.1); median PFS, 10.0 (IQR, 5.0-14.0); and high PFS, 8.0 (IQR, 5.0-13.0), without significance (p= 0.304). Patients with low PFSs required more re-PCIs than those with median and high PFSs (11.1 vs. 4.7 vs. 0.0%,p= 0.004). This association was modified for patients using P2Y12inhibitors. Among patients without P2Y12inhibitors undergoing coronary angiography, presentation of unstable CAD is independently associated with lower PR.
authors.affiliation: Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Tesse C
authors.initials: TC
authors.lastname: Leunissen
authors.affiliation: Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiology, ICIN-The Netherlands Heart Institute, Utrecht, The Netherlands.
authors.forename: Crystel M
authors.initials: CM
authors.lastname: Gijsberts
authors.affiliation: Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: Wisman
authors.affiliation: Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Huisman
authors.affiliation: Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Maarten Ten
authors.initials: MT
authors.lastname: Berg
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands; Durrer Center for Cardiogenetic Research, ICIN-The Netherlands Heart Institute, Utrecht, The Netherlands; Institute of Cardiovascular Science, University College London, London, United Kingdom.
authors.forename: Folkert W
authors.initials: FW
authors.lastname: Asselbergs
authors.affiliation: Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Imo E
authors.initials: IE
authors.lastname: Hoefer
authors.affiliation: Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pasterkamp
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Frans L
authors.initials: FL
authors.lastname: Moll
authors.affiliation: Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: de Borst
authors.affiliation: Synapse BV, Maastricht, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Roest
keywords: P2Y12 inhibitor; coronary angiography; coronary artery disease; flow cytometry; high on-treatment platelet reactivity; platelet function testing; platelet reactivity testing