Skip to main content
SpringerLink
Log in

Impact of platelet reactivity on 5-year clinical outcomes following percutaneous coronary intervention: a landmark analysis

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

We investigated the impact of suboptimal platelet reactivity on clinical outcomes after percutaneous coronary intervention (PCI). We enrolled 500 patients with stable coronary artery disease undergoing elective PCI. Platelet reactivity was measured before PCI using the VerifyNow P2Y12 assay. Primary endpoint was the incidence of ischemic or bleeding events at 1 month and 5 years. Patients with high platelet reactivity (HPR) showed significantly higher rates of ischemic events both during the 1st month after PCI (HR 2.06, 95% CI 1.02–4.06), and beyond 1 month compared with patients without HPR (HR 1.73, 95% CI 1.02–2.95). Conversely, compared with patients without low platelet reactivity (LPR), patients with LPR presented significantly higher rates of bleeding only during the 1st month (HR 3.67, 95% CI 1.68–8.02). In conclusion, pre-procedural HPR is associated with ischemic events even beyond the 1st month after PCI. The association of LPR with bleeding events seems to be confined to the periprocedural period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Authors/Task Force Members, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–2619

    Article  Google Scholar 

  2. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, Alfonso F, Macaya C, Bass TA, Costa MA (2007) Variability in individual responsiveness to clopidogrel: clinical implications, management, and future perspectives. J Am Coll Cardiol 49:1505–1516

    Article  CAS  PubMed  Google Scholar 

  3. Mangiacapra F, Patti G, Barbato E, Peace AJ, Ricottini E, Vizzi V, Gatto L, D’Ambrosio A, De Bruyne B, Wijns W, Di Sciascio G (2012) A therapeutic window for platelet reactivity for patients undergoing elective percutaneous coronary intervention: results of the ARMYDA-PROVE (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity for Outcome Validation Effort) study. JACC Cardiovasc Interv 5:281–289

    Article  PubMed  Google Scholar 

  4. Aradi D, Kirtane A, Bonello L, Gurbel PA, Tantry US, Huber K, Freynhofer MK, ten Berg J, Janssen P, Angiolillo DJ, Siller-Matula JM, Marcucci R, Patti G, Mangiacapra F, Valgimigli M, Morel O, Palmerini T, Price MJ, Cuisset T, Kastrati A, Stone GW, Sibbing D (2015) Bleeding and stent thrombosis on P2Y12-inhibitors: collaborative analysis on the role of platelet reactivity for risk stratification after percutaneous coronary intervention. Eur Heart J 36:1762–1771

    Article  CAS  PubMed  Google Scholar 

  5. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Joint ESCTFFUDOMI, Authors/Task FMC, Thygesen K, Alpert JS, White HD, Biomarker S, Jaffe AS, Katus HA, Apple FS, Lindahl B, Morrow DA, Chaitman ECGS., Clemmensen BR, Johanson PM, Hod P, Imaging H, Underwood S, Bax R, Bonow JJ, Pinto JJ, Gibbons F, Classification RJ, Fox S, Atar KA, Newby D, Galvani LK, Hamm M, Intervention CW, Uretsky S, Steg BF, Wijns PG, Bassand W, Menasche JP, Ravkilde P, Trials J, Ohman RS, Antman EM, Wallentin EM, Armstrong LC, Simoons PW, Trials ML, Januzzi RS, Nieminen JL, Gheorghiade MS, Filippatos M, Trials G, Luepker RS, Fortmann RV, Rosamond SP, Levy WD, Wood D, Trials D, Smith RS, Hu SC, Lopez-Sendon D, Robertson JL, Weaver RM, Tendera D, Bove M, Parkhomenko AA, Vasilieva AN, Mendis EJ S, ESC Committee for Practice Guidelines CPG, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Document R, Morais J, Aguiar C, Almahmeed W, Arnar DO, Barili F, Bloch KD, Bolger AF, Botker HE, Bozkurt B, Bugiardini R, Cannon C, de Lemos J, Eberli FR, Escobar E, Hlatky M, James S, Kern KB, Moliterno DJ, Mueller C, Neskovic AN, Pieske BM, Schulman SP, Storey RF, Taubert KA, Vranckx P, Wagner DR (2012) Third universal definition of myocardial infarction. J Am Coll Cardiol 60:1581–1598

    Article  PubMed  Google Scholar 

  6. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW, Academic RC (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351

    Article  PubMed  Google Scholar 

  7. Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, Bell WR, Knatterud G, Robertson TL, Terrin ML (1988) Thrombolysis in Myocardial Infarction (TIMI) Trial—phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 11:1–11

    Article  CAS  PubMed  Google Scholar 

  8. Hamilos M, Muller O, Ntalianis A, Trana C, Bartunek J, Sarno G, Mangiacapra F, Dierickx K, Meeus P, Cuisset T, De Bruyne B, Wijns W, Barbato E (2011) Relationship between peripheral arterial reactive hyperemia and residual platelet reactivity after 600 mg clopidogrel. J Thromb Thrombolysis 32:64–71

    Article  CAS  PubMed  Google Scholar 

  9. Mangiacapra F, Patti G, Peace A, Gatto L, Vizzi V, Ricottini E, D’Ambrosio A, Muller O, Barbato E, Di Sciascio G (2010) Comparison of platelet reactivity and periprocedural outcomes in patients with versus without diabetes mellitus and treated with clopidogrel and percutaneous coronary intervention. Am J Cardiol 106:619–623

    Article  CAS  PubMed  Google Scholar 

  10. Mangiacapra F, De Bruyne B, Muller O, Trana C, Ntalianis A, Bartunek J, Heyndrickx G, Di Sciascio G, Wijns W, Barbato E (2010) High residual platelet reactivity after clopidogrel: extent of coronary atherosclerosis and periprocedural myocardial infarction in patients with stable angina undergoing percutaneous coronary intervention. JACC Cardiovasc Interv 3:35–40

    Article  PubMed  Google Scholar 

  11. Mangiacapra F, Barbato E (2013) Clinical implications of platelet-vessel interaction. J Cardiovasc Transl Res 6:310–315

    Article  PubMed  Google Scholar 

  12. Muller O, Hamilos M, Bartunek J, Ulrichts H, Mangiacapra F, Holz JB, Ntalianis A, Trana C, Dierickx K, Vercruysse K, De Bruyne B, Wijns W, Barbato E (2010) Relation of endothelial function to residual platelet reactivity after clopidogrel in patients with stable angina pectoris undergoing percutaneous coronary intervention. Am J Cardiol 105:333–338

    Article  CAS  PubMed  Google Scholar 

  13. Mangiacapra F, Barbato E, Patti G, Gatto L, Vizzi V, Ricottini E, D’Ambrosio A, Wijns W, Di Sciascio G (2010) Point-of-care assessment of platelet reactivity after clopidogrel to predict myonecrosis in patients undergoing percutaneous coronary intervention. JACC Cardiovasc Interv 3:318–323

    Article  PubMed  Google Scholar 

  14. Mangiacapra F, Bartunek J, Bijnens N, Peace AJ, Dierickx K, Bailleul E, Di Serafino L, Pyxaras SA, Fraeyman A, Meeus P, Rutten M, De Bruyne B, Wijns W, van de Vosse F, Barbato E (2012) Periprocedural variations of platelet reactivity during elective percutaneous coronary intervention. J Thromb Haemost 10:2452–2461

    Article  CAS  PubMed  Google Scholar 

  15. Mangiacapra F, Cavallari I, Ricottini E, Pellicano M, Barbato E, Di Sciascio G (2015) High platelet reactivity and periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention: a significant association beyond definitions. Int J Cardiol 190:124–125

    Article  PubMed  Google Scholar 

  16. Feldman DN, Kim L, Rene AG, Minutello RM, Bergman G, Wong SC (2011) Prognostic value of cardiac troponin-I or troponin-T elevation following nonemergent percutaneous coronary intervention: a meta-analysis. Catheter Cardiovasc Interv 77:1020–1030

    Article  PubMed  Google Scholar 

  17. Prasad A, Singh M, Lerman A, Lennon RJ, Holmes DR, Rihal CS (2006) Isolated elevation in troponin T after percutaneous coronary intervention is associated with higher long-term mortality. J Am Coll Cardiol 48:1765–1770

    Article  CAS  PubMed  Google Scholar 

  18. Collet JP, Cuisset T, Rangé G, Cayla G, Elhadad S, Pouillot C, Henry P, Motreff P, Carrié D, Boueri Z, Belle L, Van Belle E, Rousseau H, Aubry P, Monségu J, Sabouret P, O’Connor SA, Abtan J, Kerneis M, Saint-Etienne C, Barthélémy O, Beygui F, Silvain J, Vicaut E, Montalescot G, ARCTIC I (2012) Bedside monitoring to adjust antiplatelet therapy for coronary stenting. N Engl J Med 367:2100–2109

    Article  CAS  PubMed  Google Scholar 

  19. Price MJ, Berger PB, Teirstein PS, Tanguay JF, Angiolillo DJ, Spriggs D, Puri S, Robbins M, Garratt KN, Bertrand OF, Stillabower ME, Stillablower ME, Aragon JR, Kandzari DE, Stinis CT, Lee MS, Manoukian SV, Cannon CP, Schork NJ, Topol EJ, GRAVITAS I (2011) Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 305:1097–1105

    Article  CAS  PubMed  Google Scholar 

  20. Trenk D, Stone GW, Gawaz M, Kastrati A, Angiolillo DJ, Müller U, Richardt G, Jakubowski JA, Neumann FJ (2012) A randomized trial of prasugrel versus clopidogrel in patients with high platelet reactivity on clopidogrel after elective percutaneous coronary intervention with implantation of drug-eluting stents: results of the TRIGGER-PCI (Testing Platelet Reactivity In Patients Undergoing Elective Stent Placement on Clopidogrel to Guide Alternative Therapy With Prasugrel) study. J Am Coll Cardiol 59:2159–2164

    Article  CAS  PubMed  Google Scholar 

  21. Mangiacapra F, Di Gioia G, Pellicano M, Di Serafino L, Bressi E, Peace AJ, Bartunek J, Wijns W, De Bruyne B, Barbato E (2016) Effects of prasugrel versus clopidogrel on coronary microvascular function in patients undergoing elective PCI. J Am Coll Cardiol 68:235–237

    Article  PubMed  Google Scholar 

  22. Mangiacapra F, Panaioli E, Colaiori I, Ricottini E, Lauria Pantano A, Pozzilli P, Barbato E, Di Sciascio G (2016) Clopidogrel versus ticagrelor for antiplatelet maintenance in diabetic patients treated with percutaneous coronary intervention: results of the CLOTILDIA study (Clopidogrel High Dose Versus Ticagrelor for Antiplatelet Maintenance in Diabetic Patients). Circulation 134:835–837

    Article  PubMed  Google Scholar 

  23. Bonaca MP, Bhatt DL, Cohen M, Steg PG, Storey RF, Jensen EC, Magnani G, Bansilal S, Fish MP, Im K, Bengtsson O, Oude Ophuis T, Budaj A, Theroux P, Ruda M, Hamm C, Goto S, Spinar J, Nicolau JC, Kiss RG, Murphy SA, Wiviott SD, Held P, Braunwald E, Sabatine MS, PEGASUS-TIMI SCAI (2015) Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 372:1791–1800

    Article  PubMed  Google Scholar 

  24. Costa F, van Klaveren D, James S, Heg D, Räber L, Feres F, Pilgrim T, Hong MK, Kim HS, Colombo A, Steg PG, Zanchin T, Palmerini T, Wallentin L, Bhatt DL, Stone GW, Windecker S, Steyerberg EW, Valgimigli M, PRECISE-DAPT SI (2017) Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 389:1025–1034

    Article  PubMed  Google Scholar 

  25. Pasea L, Chung SC, Pujades-Rodriguez M, Moayyeri A, Denaxas S, Fox KAA, Wallentin L, Pocock SJ, Timmis A, Banerjee A, Patel R, Hemingway H (2017) Personalising the decision for prolonged dual antiplatelet therapy: development, validation and potential impact of prognostic models for cardiovascular events and bleeding in myocardial infarction survivors. Eur Heart J 38:1048–1055

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mangiacapra F, Ricottini E, Barbato E, Demartini C, Peace A, Patti G, Vizzi V, De Bruyne B, Wijns W, Di Sciascio G (2015) Incremental value of platelet reactivity over a risk score of clinical and procedural variables in predicting bleeding after percutaneous coronary intervention via the femoral approach: development and validation of a new bleeding risk score. Circ Cardiovasc Interv 8:e002106

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy

    Fabio Mangiacapra, Iginio Colaiori, Elisabetta Ricottini, Antonio Creta, Giuseppe Di Gioia, Ilaria Cavallari, Edoardo Bressi, Marialessia Capuano & Germano Di Sciascio

  2. Cardiovascular Research Center Aalst, OLV Hospital, Aalst, Belgium

    Emanuele Barbato

  3. Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy

    Emanuele Barbato

Authors
  1. Fabio Mangiacapra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iginio Colaiori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisabetta Ricottini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Creta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Giuseppe Di Gioia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ilaria Cavallari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Edoardo Bressi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marialessia Capuano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Emanuele Barbato
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Germano Di Sciascio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabio Mangiacapra.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mangiacapra, F., Colaiori, I., Ricottini, E. et al. Impact of platelet reactivity on 5-year clinical outcomes following percutaneous coronary intervention: a landmark analysis. J Thromb Thrombolysis 45, 496–503 (2018). https://doi.org/10.1007/s11239-018-1630-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-018-1630-5

Keywords

Search

Navigation