High On-Treatment Platelet Reactivity After Prasugrel Loading Dose and Cardiovascular Events After Percutaneous Coronary Intervention in Acute Coronary Syndromes

被引：185

作者：

Bonello, Laurent ^{[1
,2
]}

Pansieri, Michel ^{[3
]}

Mancini, Julien ^{[4
,5
]}

Bonello, Roland ^{[6
]}

Maillard, Luc ^{[7
]}

Barnay, Pierre ^{[3
]}

Rossi, Philippe ^{[8
]}

Ait-Mokhtar, Omar ^{[1
]}

Jouve, Bernard ^{[9
]}

Collet, Frederic ^{[6
]}

Peyre, Jean Pascal ^{[10
]}

Wittenberg, Olivier ^{[11
]}

de Labriolle, Axel ^{[12
]}

Camilleri, Elise ^{[13
]}

Cheneau, Edouard ^{[14
]}

Cabassome, Elma ^{[1
]}

Dignat-George, Francoise ^{[2
,15
]}

Camoin-Jau, Laurence ^{[2
,15
]}

Paganelli, Franck ^{[1
]}

机构：

[1] Hop Univ Nord, Dept Cardiol, Fac Med, F-13015 Marseille, France

[2] INSERM, UMRS 608, UFR Pharm, F-13258 Marseille, France

[3] Hop Avignon, Serv Cardiol, Avignon, France

[4] Serv Sante Publ & Informat Med, Marseille, France

[5] Aix Marseille Univ, Fac Med, LERTIM EA 3283, Marseille, France

[6] Clin Clairval, Serv Cardiol, Marseille, France

[7] Clin Axium, Serv Cardiol, Aix En Provence, France

[8] Clin Marignane, Serv Cardiol, Marignane, France

[9] Hop Aix En Prov, Serv Cardiol, Aix En Provence, France

[10] Clin Vert Coteaux, Serv Cardiol, Marseille, France

[11] Clin Beauregard, Serv Cardiol, Marseille, France

[12] Clin Pont Chaume, Serv Cardiol, Montauban, France

[13] Hop Martigues, Serv Cardiol, Martigues, France

[14] Clin Bouchard, Serv Cardiol, Marseille, France

[15] Hop Conception, Serv Hematol, Marseille, France

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2011年 / 58卷 / 05期

关键词：

antiplatelet therapy; high on-treatment platelet reactivity; platelet monitoring; P2Y(12)-ADP receptor antagonist; stent thrombosis; VASP index; CLOPIDOGREL-TREATED PATIENTS; STENT THROMBOSIS; AGGREGATION;

D O I：

10.1016/j.jacc.2011.04.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to investigate the relationship between platelet reactivity (PR) after a loading dose (LD) of prasugrel and thrombotic events. Background Post-treatment PR has been shown to be strongly associated with the occurrence of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI) in the clopidogrel era. Prasugrel is a new P2Y(12)-adenosine diphosphate receptor with a higher potency on PR. Methods A prospective multicenter study included patients who underwent successful PCI for acute coronary syndromes and received prasugrel therapy. Vasodilator-stimulated phosphoprotein (VASP) index was measured after the prasugrel LD. High on-treatment PR was defined as a VASP index >= 50%. MACE included cardiovascular death, myocardial infarction, and definite stent thrombosis at 1 month. Results Three hundred one patients were enrolled. The mean VASP index after 60 mg of prasugrel was 34.3 +/- 23.1%. High on-treatment PR was observed in 76 patients (25.2%). Patients experiencing thrombotic events after PCI had significantly higher VASP indexes compared with those free of events (64.4 +/- 14.4% vs. 33.4 +/- 22.7%; range: 51% to 64% and 5% to 47.6%, respectively; p = 0.001). Kaplan-Meier analysis comparing good responders and patients with high on-treatment PR demonstrated a significantly higher rate of MACE in patients with suboptimal PR inhibition (log-rank p < 0.001). Receiver-operating characteristic curve analysis found a cutoff value of 53.5% of the VASP index to predict thrombotic events at 1 month (r = 0.86, p < 0.001). Patients with minor or major Thrombolysis In Myocardial Infarction unrelated to coronary artery bypass grafting bleeding and those without had similar VASP indexes (30 +/- 17.8% vs. 34.3 +/- 23%, p = 0.70). Conclusions Despite the use of prasugrel, a significant number of patients undergoing PCI in the setting of acute coronary syndromes do not achieve optimal PR inhibition. Such patients have a higher risk for MACE after PCI. (J Am Coll Cardiol 2011; 58: 467-73) (C) 2011 by the American College of Cardiology Foundation

引用

页码：467 / 473

页数：7

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