HIGH ON-TREATMENT PLATELET REACTIVITY: RISK FACTORS AND 3- YEARS OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME

Sborník

Background. High on-treatment platelet reactivity (HTPR) is expected to be a negative prognostic factor in patients with stable coronary artery disease. But in patients with acute coronary syndrome the data about prognostic value and association with risk factors are lacking.Objectives: The aim of the study was to assess the relationship between HTPR, potential risk factors and with threeyear mortality in patients with acute coronary syndromes. Patients and Methods. We performed a prospective cohort study of 198 patients with acute coronary syndrome. In these patients the response to aspirin and clopidogrel was assessed by the impedance aggregometry. According to the response to antiplatelet treatment patients were divided in groups with sufficient response, dual poor responsiveness (DPR), poor responsiveness to aspirin (PRA) and poor responsiveness to clopidogrel (PRC). Simultaneously the age, gender, left ventricle ejection fraction, presence of heart failure, diabetes mellitus and smoking habit was recorded. After three years, the myocardial reinfarction incidence and overall mortality were assessed. Results. Poor response to antiplatelet treatment was significantly more frequent in patients in NYHA III and IV class (HR 8.35, 95 % CI 3.7-18.8, p<0.0001 for DPR, HR 3.47 95 % CI 1.95- 5.57, p<0.0001 for PRA, HR 4.34, 95 % CI 2.58 - 6.51, p<0.0001 for PRC) and in patients with left ventricle systolic dysfunction (HR 1.86, 95 % CI 3.29-1.34, p<0.05 for PRA). Three-year mortality was significantly higher in all groups of patients with HTPR compared with patients with sufficient response to antiplatelet treatment: in patients with poor responsiveness to aspirin 31.7 % vs. 11.5 %, p <0.01, with poor responsiveness to clopidogrel 33.3 % vs. 10.9 %, p<0.001 and with poor response to both aspirin and clopidogrel 40.9 % vs. 12.5 %, p<0.001. Risk of repeated myocardial infarction was increased as well (HR 4.0, 95 % CI 1.25-11.5, p<0.05 for DPR, HR 4.37, 95 % CI 1.51-12.77, p<0.01 for PRA, HR 3.25, 95 % CI 1.11-9.36, p<0.05 for PRC). Conclusions. Poor response to aspirin, clopidogrel or both aspirin and clopidogrel are strong negative risk factors of death and repeated myocardial infarction in patients with acute coronary syndrome. We found a heart failure and left ventricle systolic dysfunction to be risk factors of HTPR development.

Haematologica, 2012; 97(s1):  191