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Posttreatment platelet reactivity on clopidogrel is associated with the risk of adverse events after off-pump coronary artery bypass

Authors
 Young-Nam Youn  ;  Gijong Yi  ;  Sak Lee  ;  Hyun-Chel Joo  ;  Kyung-Jong Yoo 
Citation
 AMERICAN HEART JOURNAL, Vol.167(6) : 818-25, 2014 
Journal Title
AMERICAN HEART JOURNAL
ISSN
 0002-8703 
Issue Date
2014
MeSH
Aged ; Aspirin/therapeutic use* ; Blood Platelets/drug effects ; Cohort Studies ; Coronary Artery Bypass, Off-Pump* ; Coronary Artery Disease/drug therapy* ; Coronary Artery Disease/mortality ; Coronary Artery Disease/surgery ; Drug Resistance* ; Drug Therapy, Combination ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/mortality ; Myocardial Infarction/prevention & control* ; Myocardial Revascularization ; Platelet Activation* ; Platelet Aggregation/drug effects ; Platelet Aggregation Inhibitors/therapeutic use* ; Prospective Studies ; ROC Curve ; Ticlopidine/analogs & derivatives* ; Ticlopidine/therapeutic use
Abstract
BACKGROUND:
Dual antiplatelet therapy with aspirin and clopidogrel is currently recommended in off-pump coronary artery bypass (OPCAB). However, no data exist concerning platelet reactivity on clopidogrel after OPCAB. The aim of this study was to assess the relationship between platelet reactivity and late major adverse cardiovascular events (MACEs) after OPCAB.
METHODS:
In this prospective, single-center, observational study, on-clopidogrel platelet reactivity was measured using a point-of-care assay (VerifyNow system; Accumetrics Inc, San Diego, CA) in 859 patients who underwent OPCAB with 1 or more vein grafts. The primary end point was late MACEs (30 days-1 year) including cardiac death, nonfatal myocardial infarction, and target vessel revascularization. Receiver operating characteristic curve analysis was used to estimate the cutoff value of P2Y12 reaction units (PRUs) for MACEs.
RESULTS:
The optimal cutoff value for posttreatment reactivity for the incidence of late MACEs was ≥188 PRU (area under the curve 0.72, 95% CI 0.68-0.75, P = .002). The incidence of late MACEs was significantly higher in the high platelet reactivity (HPR; ≥188 PRU) group than in the low platelet reactivity (<188 PRU) group (3.6% vs. 1.4%, P = .040). Kaplan-Meier analysis revealed 1-year MACE-free survival rates of 98.4% ± 0.5% and 95.9% ± 1.3% in the low platelet reactivity and HPR groups, respectively (P = .034). According to a Cox regression hazard model, HPR was an independent risk factor for late MACE-free survival (hazard ratio 3.51, 95% CI 1.27-9.69, P = .015).
CONCLUSION:
High residual platelet reactivity after clopidogrel administration is strongly associated with 1-year MACE-free survival. Routine measurement of platelet reactivity and thorough monitoring of patients with HPR after OPCAB are warranted.
Full Text
http://www.sciencedirect.com/science/article/pii/S0002870314000908
DOI
10.1016/j.ahj.2014.01.016
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Youn, Young Nam(윤영남)
Yi, Gi Jong(이기종)
Lee, Sak(이삭) ORCID logo https://orcid.org/0000-0001-6130-2342
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98850
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