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Clinical Significance of Laboratory-determined Aspirin Poor Responsiveness After Primary Percutaneous Coronary Intervention

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Abstract

Aims

The objective of the present substudy was to examine whether aspirin poor/high responsiveness (APR/AHR) is associated with increased rates of major adverse cardiovascular events (MACE) and serious bleeding after primary percutaneous coronary intervention (PPCI).

Methods

We analyzed 961 consecutive ST-elevation acute myocardial infarction patients who underwent PPCI between February 2008 and June 2011. Multiplate analyser (Dynabite, Munich, Germany) was used for the assessment of platelet reactivity. APR/AHR were defined as the upper/lower quintiles of ASPI values, determined 24 h after aspirin loading. APR patients were tailored using 300 mg maintenance dose for 30 days. The co-primary end points at 30 days were: MACE (death, non-fatal infarction, ischemia-driven target vessel revascularization and ischemic stroke) and serious bleeding according to the BARC classification.

Results

One hundred and 90 patients were classified as APR, and 193 patients as AHR. At admission, compared with aspirin sensitive patients (ASP), patients with APR had more frequently diabetes, anterior infarction and heart failure, while AHR patients had reduced values of creatine kinase, leukocytes, heart rate and systolic blood pressure. Compared with ASP, the rates of 30-day primary end points did not differ neither in APR group including tailored patients (MACE, adjusted OR 1.02, 95%CI 0.47-2.17; serious bleeding, adjusted OR 1.92, 95%CI 0.79-4.63), nor in patients with AHR (MACE, adjusted OR 1.58, 95%CI 0.71-5.51; serious bleeding, adjusted OR 0.69, 95%CI 0.22-2.12).

Conclusions

The majority of APR patients were suitable for tailoring. Neither APR including tailored patients nor AHR were associated with adverse 30-day efficacy or safety clinical outcomes.

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Abbreviations

PPCI:

Primary percutaneous coronary intervention

APR:

Aspirin poor responsiveness

AHR:

Aspirin high responsiveness

ASP:

Aspirin sensitive patients

MACE:

Major adverse cardiovascular events

STEMI:

ST-elevation myocardial infarction

ART-PCI:

The Antiplatelet Regimen Tailoring after primary PCI trial

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Acknowledgments

This work was supported by the Ministry of Science and Technological Development of the Republic of Serbia, Contract No. 172033. The authors express their gratitude to all physicians and nurses of the Clinical Center’s of Serbia Coronary Unit and Catheterization Laboratory who took part in this study.

Author information

Authors and Affiliations

  1. University of Belgrade School of Medicine, Belgrade, Serbia

    Igor Mrdovic, Gordana Krljanac, Ratko Lasica, Milika Asanin & Jelena Marinkovic

  2. Clinical Center of Serbia, Emergency Hospital & Cardiology Clinic, Coronary Care Unit A, Pasterova 2, Belgrade, 11 000, Serbia

    Igor Mrdovic, Lidija Savic, Gordana Krljanac, Ratko Lasica & Milika Asanin

  3. Institute of Cardiovascular Diseases Dedinje, Belgrade, Serbia

    Mirko Čolić

  4. 2nd Department of Internal Medicine, Faculty of Medicine, Masaryk University, Pekarska 53, Brno, Czech Republic

    Peter Kruzliak

  5. Center for Medical Biochemistry, School of Pharmacy University of Belgrade, Clinical Center of Serbia, Belgrade, Serbia

    Sanja Stanković

  6. Institute for Medical Statistics and Informatics, Belgrade, Serbia

    Jelena Marinkovic

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  1. Igor Mrdovic
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  2. Mirko Čolić
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Correspondence to Igor Mrdovic.

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Mrdovic, I., Čolić, M., Savic, L. et al. Clinical Significance of Laboratory-determined Aspirin Poor Responsiveness After Primary Percutaneous Coronary Intervention. Cardiovasc Drugs Ther 30, 151–158 (2016). https://doi.org/10.1007/s10557-016-6643-8

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