Clinical Significance of Laboratory-determined Aspirin Poor Responsiveness After Primary Percutaneous Coronary Intervention
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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).
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.
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).
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.
KeywordsAspirin resistance Primary PCI Clinical outcome
Primary percutaneous coronary intervention
Aspirin poor responsiveness
Aspirin high responsiveness
Aspirin sensitive patients
Major adverse cardiovascular events
ST-elevation myocardial infarction
The Antiplatelet Regimen Tailoring after primary PCI trial
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.
Compliance with Ethical Standards
Conflict of Interest
- 6.Eikelboom JW, Hankey GJ, Thom J, et al., for the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization. Management and avoidance (CHARISMA) investigators. Incomplete inhibition of thromboxane biosynthesis by acetylsalicylic acid: determinants and effect on cardiovascular risk. Circulation 2008;118:1705–12.Google Scholar
- 10.Marcucci R, Gori AM, Paniccia R, et al. Cardiovascular death and nonfatal myocardial infarction in acute coronary syndrome patients receiving coronary stenting are predicted by residual platelet reactivity to ADP detected by a point-of-care assay. A 12-month follow-up. Circulation. 2009;119:237–42.CrossRefPubMedGoogle Scholar
- 15.Mehta SR, Tanguay JF, Eikelboom JW, et al, on behalf of the CURRENT-OASIS 7 trial investigators. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet 2010; 376: 1233–43.Google Scholar
- 16.Campo G, Fileti L, de Cesare N, et al, on behalf of the 3 T/2R Investigators. Long-term clinical outcome based on aspirin and clopidogrel responsiveness status after elective percutaneous coronary intervention. A 3 T/2R (tailoring treatment with tirofiban in patients showing resistance to aspirin and/or resistance to clopidogrel) trial substudy. J Am Coll Cardiol 2010; 56:1447–55.Google Scholar
- 22.Pettersen AR, Seljeflot I, Abdelnoor M, et al. High on-aspirin platelet reactivity and clinical outcome in patients with stable coronary artery disease: results from ASCET (Aspirin Nonresponsiveness and Clopidogrel Endpoint Trial). J Am Heart Assoc. 2012;1:e000703.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Mehran R, Rao S, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials. A consensus report from the bleeding academic research consortium Circulation 2011; 123:2736–47.Google Scholar
- 28.Frelinger 3rd AL, Furman MI, Linden MD, et al. Residual arachidonic acid-induced platelet activation via an adenosine diphosphate-dependent but cyclooxygenase-1 and cyclooxygenase 2-independent pathway. A 700-patient study of aspirin resistance. Circulation. 2006;113:2888–96.CrossRefPubMedGoogle Scholar
- 34.Price MJ, Berger PB, Teirstein PS, et al, for the GRAVITAS Investigators. Standard- versus high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention The GRAVITAS Randomized Trial JAMA 2011; 305:1097–1105.Google Scholar
- 40.Patrono C, Baigent C, Hirsh J, Roth G, American College of Chest Physicians. Antiplatelet drugs: evidence-based clinical practice guidelines (8th Edition). Chest. 2008;133:199S–233S.Google Scholar