Abstract
Studies on platelet reactivity (PR) testing commonly test PR only after percutaneous
coronary intervention (PCI) has been performed. There are few data on pre- and post-PCI
testing. Data on simultaneous testing of aspirin and adenosine diphosphate antagonist
response are conflicting. We investigated the prognostic value of combined serial
assessments of high on-aspirin PR (HASPR) and high on-adenosine diphosphate receptor
antagonist PR (HADPR) in patients with acute coronary syndrome (ACS). HASPR and HADPR
were assessed in 928 ACS patients before (initial test) and 24 hours after (final
test) coronary angiography, with or without revascularization. Patients with HASPR
on the initial test, compared with those without, had significantly higher intraprocedural
thrombotic events (IPTE) (8.6 vs. 1.2%, p ≤ 0.001) and higher 30-day major adverse cardiovascular and cerebrovascular events
(MACCE; 5.2 vs. 2.3%, p = 0.05), but not 12-month MACCE (13.0 vs. 15.1%, p = 0.50). Patients with initial HADPR, compared with those without, had significantly
higher IPTE (4.4 vs. 0.9%, p = 0.004), but not 30-day (3.5 vs. 2.3%, p = 0.32) or 12-month MACCE (14.0 vs. 12.5%, p = 0.54). The c-statistic of the Global Registry of Acute Coronary Events (GRACE)
score alone, GRACE score + ASPR test and GRACE score + ADPR test for discriminating
30-day MACCE was 0.649, 0.803 and 0.757, respectively. Final ADPR was associated with
30-day MACCE among patients with intermediate-to-high GRACE score (adjusted odds ratio
[OR]: 4.50, 95% confidence interval [CI]: 1.14–17.66), but not low GRACE score (adjusted
OR: 1.19, 95% CI: 0.13–10.79). In conclusion, both HASPR and HADPR predict ischaemic
events in ACS. This predictive utility is time-dependent and risk-dependent.
Keywords
antiplatelet therapy - acute coronary syndrome - thrombosis
