An Observational Study of the Relationship Between Outcome and Platelet Reactivity in Chinese Patients Undergoing PCI Loading with 600 mg Clopidogrel

Abstract

Objectives: We sought to determine whether high posttreatment platelet reactivity (HPPR) to a 600 mg loading dose of clopidogrel affects outcomes in Chinese patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI) and to investigate whether there is a relationship between the number of platelet reactivityunits (PRUs) and the characteristics of the patients.Background: Although impaired platelet response to clopidogrel is a strong predictor of unfavorable outcome after PCI, the impact of HPPR to a 600 mg loading dose of clopidogrel in Chinese patients with ACS undergoing PCI is still unknown.Methods: We performed observational research on 134 unselected patients with ACS undergoing urgent or planned PCI with a 600 mg loading dose of clopidogrel. Platelet activation was expressed as the PRU value measured by the VerifyNow assay.Results: Among the 134 patients (mean age 60.62 years [standard deviation 9.13 years], 60.4% male), there were 46patients with HPPR (34.3%) and 88 patients without HPPR (65.7%). At a mean follow-up of 6 months (standard deviation 1 month), the rates of cardiac death, unstable angina, and rehospitalization for target lesion revascularization werehigher in the HPPR group (19.6% vs. 6.8%, P = 0.029). Multivariate analysis identified hemoglobin level and sex as independent predictors of the PRU value (y = 456.355 − 1.736x1 − 31.880x2, P < 0.05). On receiver operating characteristiccurve analysis, PRU values could significantly discriminate between patients with and patients without cardiac death,unstable angina, and rehospitalization for target lesion revascularization (area under the curve 0.758, 95% confidenceinterval 0.62–0.85, P = 0.001, P < 0.05).Conclusion: In patients with ACS, HPPR to a 600 mg loading dose of clopidogrel is associated with worse outcomes after PCI. There is some relationship between the PRU value and the hemoglobin level and sex. PRU values can predict the prognosis.

The Neutrophil/Lymphocyte Ratio is Associated with Different Stages of Development of Coronary Artery Disease

“…Persistent inflammation produces megakaryocyte proliferation and increase platelet production. Platelet activation is implicated in the pathophysiology of diseases prone to thrombosis and inflammation [17]. PLR is a marker that reflects both the aggregation status and inflammation pathway status [18].…”