Evaluation of Clinical Risk Factors to Predict High On-Treatment Platelet Reactivity and Outcome in Patients with Stable Coronary Artery Disease (PREDICT-STABLE)

Droppa, Michal; Tschernow, Dimitri; Müller, Karin; Tavlaki, Elli; Karathanos, Athanasios; Stimpfle, Fabian; Schaeffeler, Elke; Schwab, Matthias; Tolios, Alexander; Siller‐Matula, Jolanta M.; Gawaz, Meinrad; Geisler, Tobias

doi:10.1371/journal.pone.0121620

Cited by 40 publications

(37 citation statements)

References 49 publications

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“…In the present study, however, we found no effect of age, sex, type 2 diabetes mellitus, prior myocardial infarction, smoking, or body mass index on any end points. This result conflicts with recent articles showing the influence of clinical risk factors on major adverse cardiovascular events in patients on dual‐antiplatelet therapy with aspirin and clopidogrel …”

Section: Discussioncontrasting

confidence: 87%

“…This result conflicts with recent articles showing the influence of clinical risk factors on major adverse cardiovascular events in patients on dual-antiplatelet therapy with aspirin and clopidogrel. 36,37 The low event rate may partly explain our results because only 5.9% of patients in the fourth aggregation quartile reached the primary end point, which was considerably lower than the expected 15% used in our sample size calculation. We used classical clinical end points, and despite studying a group of stable CAD patients with a high-risk clinical profile, our study had lower event rates than comparable studies.…”

Section: Discussionmentioning

confidence: 75%

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Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease

Larsen

Grove

Neergaard‐Petersen

et al. 2017

JAHA

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BackgroundIncreased platelet aggregation during antiplatelet therapy may predict cardiovascular events in patients with coronary artery disease. The majority of these patients receive aspirin monotherapy. We aimed to investigate whether high platelet‐aggregation levels predict cardiovascular events in stable coronary artery disease patients treated with aspirin.Methods and ResultsWe included 900 stable coronary artery disease patients with either previous myocardial infarction, type 2 diabetes mellitus, or both. All patients received single antithrombotic therapy with 75 mg aspirin daily. Platelet aggregation was evaluated 1 hour after aspirin intake using the VerifyNow Aspirin Assay (Accriva Diagnostics) and Multiplate Analyzer (Roche; agonists: arachidonic acid and collagen). Adherence to aspirin was confirmed by serum thromboxane B2. The primary end point was the composite of nonfatal myocardial infarction, ischemic stroke, and cardiovascular death. At 3‐year follow‐up, 78 primary end points were registered. The primary end point did not occur more frequently in patients with high platelet‐aggregation levels (first versus fourth quartile) assessed by VerifyNow (hazard ratio: 0.5 [95% CI, 0.3–1.1], P=0.08) or Multiplate using arachidonic acid (hazard ratio: 1.0 [95% CI, 0.5–2.1], P=0.92) or collagen (hazard ratio: 1.4 [95% CI, 0.7–2.8], P=0.38). Similar results were found for the composite secondary end point (nonfatal myocardial infarction, ischemic stroke, stent thrombosis, and all‐cause death) and the single end points. Thromboxane B2 levels did not predict any end points. Renal insufficiency was the only clinical risk factor predicting the primary and secondary end points.ConclusionsThis study is the largest to investigate platelet aggregation in stable coronary artery disease patients receiving aspirin as single antithrombotic therapy. We found that high platelet‐aggregation levels did not predict cardiovascular events.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 75%

Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease

Larsen

Grove

Neergaard‐Petersen

et al. 2017

JAHA

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“…PR in patients on P2Y 12 inhibitors undergoing PCI was strongly influenced by clinical risk variables such as age, BMI, diabetes mellitus, serum creatinine, and left ventricular function. 28 An inverse trend for the correlation between PR and markers for renal function, creatinine, and urea was also found in patients with critical limb ischemia.…”

mentioning

confidence: 89%

Lower Platelet Reactivity Is Associated with Presentation of Unstable Coronary Artery Disease

et al. 2016

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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 P2Y12 inhibitors. 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 P2Y12 inhibitor use (long-term and preprocedural versus none). Surprisingly, among non-P2Y12 inhibitor 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 P2Y12 inhibitors. Among patients without P2Y12 inhibitors undergoing coronary angiography, presentation of unstable CAD is independently associated with lower PR.

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“…As regards novelty, the PREDICT score have has already been used in clopidogrel studies. 8,25,26 Notably, CYP2C19 activity has not been evaluated in those papers. On the other hand, Geisler et al have reported on the correlation between CYP2C19 polymorphism and non-genetic risk factors (PREDICT score) with high residual platelet reactivity (RPA) in patients with symptomatic coronary artery disease subjected to percutaneous coro-nary intervention.…”

Section: To Editormentioning

confidence: 99%

PREDICT score and CYP2C19 polymorphism independently predict lack of efficacy of clopidogrel in cardiology patients

Mugosa

Djordjević

Bukumirić

et al. 2016

Clin Exp Pharma Physio

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Evaluation of Clinical Risk Factors to Predict High On-Treatment Platelet Reactivity and Outcome in Patients with Stable Coronary Artery Disease (PREDICT-STABLE)

Cited by 40 publications

References 49 publications

Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease

Reduced Antiplatelet Effect of Aspirin Does Not Predict Cardiovascular Events in Patients With Stable Coronary Artery Disease

Lower Platelet Reactivity Is Associated with Presentation of Unstable Coronary Artery Disease

PREDICT score and CYP2C19 polymorphism independently predict lack of efficacy of clopidogrel in cardiology patients

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