Impact of Platelet Reactivity After Clopidogrel Administration on Drug-Eluting Stent Thrombosis

Buonamici, Piergiovanni; Marcucci, Rossella; Migliorini, Angela; Gensini, Gian Franco; Santini, Alberto; Paniccia, Rita; Moschi, Guia; Gori, Anna Maria; Abbate, Rosanna; Antoniucci, David

doi:10.1016/j.jacc.2007.01.094

Cited by 616 publications

(424 citation statements)

References 33 publications

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“…24 Our results support the view that STEMI was a significant independent predictor of stent thrombosis. 25 Our study has several potential limitations. First, 3 of the 4 trials included in this meta-analysis had a protocolmandated follow-up angiography.…”

Section: Discussionmentioning

confidence: 88%

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

Zheng

Lu³

et al. 2010

Clinical Cardiology

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Background: It has been reported that sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) have been more effective than bare-metal stents in reducing restenosis and cardiac events in a broad range of patients with coronary artery disease. However, it is unknown whether there might be differences between these two drug-eluting stents in terms of efficacy and safety in the setting of acute ST-segment elevation myocardial infarction (STEMI). Hypothesis: The aim of the present study was to compare SES with PES in patients with acute STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: The published research was scanned by formal searches of electronic databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) from January 2001 to February 2010. Internet-based sources of information on the results of clinical trials in cardiology were also searched. Results: A total of 4 randomized trials were included in the present meta-analysis, involving 1105 patients (550 in the SES group, 555 in the PES group). SES were significantly more effective in the reduction of angiographic binary (≥50%) restenosis (4.0% vs 9.6%, odds ratio 0.38, 95% confidence interval 0.19 to 0.74, P = 0.004) compared to PES. The differences between SES and PES were not statistically significant with respect to target vessel revascularization (TVR), stent thrombosis, cardiac death, and myocardial infarction. Conclusions: SES are superior to PES in reducing the incidence of restenosis in patients undergoing primary PCI for STEMI, with nonsignificant differences in terms of TVR, cardiac death, myocardial infarction, and stent thrombosis. IntroductionPrimary angioplasty has become the standard of care for acute ST-segment elevation myocardial infarction (STEMI); however, its long-term success is limited by the occurrence of restenosis. 1,2 The introduction of drugeluting stents (DES) has greatly alleviated this problem, 3 and their use in coronary intervention has markedly increased. DES decreases angiographic and clinical measurements of restenosis compared with bare metal stents 4,5 in elective patients and those with STEMI. A meta-analysis in a broad population has shown that sirolimus-eluting stents (SES) are superior to paclitaxel-eluting stents (PES) in terms of late loss and target lesion revascularization (TLR). 6 However, the relative efficacy and safety of SES and PES in STEMI patients remains unclear. We therefore performed a meta-analysis of randomized

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Section: Discussionmentioning

confidence: 88%

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

Zheng

Lu³

et al. 2010

Clinical Cardiology

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“…В литературе накапливается все больше доказательств того, что высокие значения остаточной реактивности тромбоцитов, определенные in vitro у пациентов, получающих ДАТ, сопровождается риском таких нежелательных явлений, как тромбоз стента и смерть от сердечно-сосудистых событий [12,13]. В исследовании RECLOSE [14] у лиц с лабора-торной резистентностью к проводимой ДАТ частота тромбоза стента оказалась значительно выше, чем у больных, чувствительных к АТ.…”

Section: Discussionunclassified

The “Protocol” Study: Preliminary Results

et al. 2015

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Aim.To reveal the association of gene polymorphism CYP2С19*2 and recurrent early stent thrombosis in coronary vessels, and paradoxal response to clopidogrel intake in patients -the inhabitants of Siberian Region -after acute coronary syndrome. Material and methods. Totally 105 patients studied, hospitalized for stenting of coronary arteries in acute coronary syndrome, never received clopidogrel previously. The polymorphism of studied СУР2С19: *2, *3, *17 alleles, as assessment of platelet aggregation with ADP before and after clopidogrel intake, as of endpoints on safety and efficacy during 30 days (thrombotic complications, bleeding). Results. Within the selected patients there was no any significant association of any CYP2С19*2 and/or CYP2С19*3 alleles and paradoxic laboratory reaction. There was significant association of the CYP2C19*17 gene carriage and bleedings. When comparing the groups of patients having or not having complications related to clopidogrel (thrombotic or bleedings), there was significant difference in residual platelet aggregation. Conclusion.The results of the study might be strongly significant for the decisions making on double antiplatelet therapy and on the tactics of drugs preference. Russ

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“…Despite its proven benefit, inhibition of platelet function by clopidogrel treatment is characterised by large interindividual variability. It has been shown that hyporesponsiveness of platelets to clopidogrel therapy is an independent strong predictor of stent thrombosis [2,3]. We report a case of simultaneous stent thrombosis in a patient with acute myocardial infarction who had an established clopidogrel hyporesponsiveness.…”

Section: Introductionmentioning

confidence: 87%

Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

2011

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A 57-year-old male patient without cardiovascular history suffered an acute myocardial infarction and underwent drug-eluting stent implantation in the left anterior descending artery. A few days later, the right coronary artery was also stented (drug-eluting stent). Three days later, he was re-admitted to our hospital in cardiogenic shock. Emergent coronary angiography showed total occlusion of both stents. Platelet function analysis (PFA) showed attenuated platelet inhibition in response to clopidogrel treatment. The patient was the carrier of a loss-of-function polymorphism in the CYP2C19 gene, which has been associated with increased incidence of adverse thrombotic events. Antiplatelet therapy was switched to prasugrel and PFA revealed an adequate antiplatelet effect.

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Impact of Platelet Reactivity After Clopidogrel Administration on Drug-Eluting Stent Thrombosis

Abstract: Nonresponsiveness to clopidogrel is a strong independent predictor of stent thrombosis in patients receiving sirolimus- or paclitaxel-eluting stents.

Cited by 616 publications

References 33 publications

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

Comparison of Sirolimus‐ and Paclitaxel‐Eluting Stents in Patients Undergoing Primary Percutaneous Coronary Intervention for ST‐Elevation Myocardial Infarction: A Meta‐analysis of Randomized Trials

The “Protocol” Study: Preliminary Results

Early double stent thrombosis associated with clopidogrel hyporesponsivenesss

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