Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Matthias K. Freynhofer; Ivan Brozovic; Veronika Bruno; Serdar Farhan; Birgit Vogel; Gabriele Jakl; Martin Willheim; Wolfgang Hübl; Johann Wojta; Kurt Huber

doi:10.1160/TH11-02-0077

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(02): 230-239
DOI: 10.1160/TH11-02-0077

Theme Issue Article

Schattauer GmbH

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Authors

Matthias K. Freynhofer

¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria

²Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
Ivan Brozovic

¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
Veronika Bruno

¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria

³Department of Obstetrics and Gynecology, Wilhelminenhospital, Vienna, Austria
Serdar Farhan

¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
Birgit Vogel

¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
Gabriele Jakl

¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
Martin Willheim

⁴Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
Wolfgang Hübl

⁴Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria
Johann Wojta

²Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria

⁵Department of Cardiology, Medical University of Vienna, Vienna, Austria
Kurt Huber

¹3^rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria

²Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria

Abstract

Summary

Reduced antiplatelet effect of clopidogrel assessed with multiple electrode aggregometry (MEA) and vasodilator stimulated phosphoprotein-phosphorylation (VASP-P) assay has been proven to predict major adverse cardiovascular events (MACE) after coronary stenting. So far no consecutive registry has evaluated the usefulness of different adenosine diphosphate-based platelet function tests to predict outcome in unselected patients. Hence, our objective was to determine the feasibility of MEA and VASP-P for clinical routine and whether low-response to clopidogrel as determined by MEA and/or the VASP-P assays predicts MACE in a “real-life” population undergoing coronary stenting. Threehundred consecutive patients were included in this prospective registry. Blood was sampled 6–24 hours after stenting to measure MEA and VASP-P. The use of glycoprotein-IIb/IIIa-blockers limited MEA to 196 measurements. Concerning the VASP-P assay, 300 measurements were achieved. Receiver Operating Characteristics (ROC)-curves of sensitivity and specificity estimates for MACE were plotted for VASP-P assay. The area under the ROC-curve was 0.683 (p=0.014) for the platelet reactivity index (PRI) calculated from median fluorescence intensities (FI) with an optimal cut-off at 60.2% PRI. Patients above 60.2% had a significantly increased risk for MACE at six months follow-up (p=0.007). Estimating the cut-offs for the PRI from mean FI (52%) or from geometric mean FI (56.6%) led to clinically relevant differences. VASP-P assay is feasible for clinical routine to measure clopidogrel effects and to predict post-procedural MACE in unselected patients. With regard to differing cut-offs, exact standardisation of the VASP-P assay is mandatory. The use of GP-IIb/IIIa-blockers prevents MEA testing and limits its usability in unselected patients.

Keywords

Platelet function testing - clopidogrel - high on-treatment platelet reactivity - prospective registry

Full Text

References

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