High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study

Roberta De Rosa, Tullio Palmerini, Stefano De Servi, Marta Belmonte, Gabriele Crimi, Stefano Cornara, Paolo Calabrò, Marco Cattaneo, Diego Maffeo, Anna Toso, Antonio Bartorelli, Cataldo Palmieri, Marco De Carlo, Davide Capodanno, Philippe Genereux, Dominick Angiolillo, Federico Piscione, Gennaro Galasso

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI.

METHODS: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel. Major adverse cardiac events (MACE) were assessed up to 1 year-follow-up.

RESULTS: Elderly with HPR at discharge showed a significantly higher incidence of overall MACE (13 vs 4%, p = .006), cardiac death (6 vs 0.7%, p = .020), myocardial infarction (MI, 12 vs 4%, p = .031) and a trend for higher stent-thrombosis (5 vs 0.7%, p = .068). Similarly, elderly with 1-month-HPR showed between 1 month and 1 year significantly higher incidence of MACE (10 vs 4%, p = .012), cardiac death (6 vs 0.7%, p = .019) and composite cardiac death/MI (11 vs 4%, p = .014). Up to 1 year, elderly with HPR showed a 4-fold increased risk of MACE compared to both elderly without HPR (for discharge-HPR: p = .005; for 1-month-HPR: p = .01) and non-elderly with HPR (for discharge-HPR: p < .001; for 1-month-HPR: p < .0001). At multivariable analysis, HPR could independently predict 1-year-MACE in elderly (for discharge-HPR: HR = 3.191, CI: 1.373-7.417, p = .007; for 1-month-HPR: HR = 3.542, CI: 1.373-9.137, p = .009).

CONCLUSIONS: In elderly with NSTE-ACS undergoing PCI and treated with clopidogrel, HPR was independently associated with an increased risk of MACE up to 1 year.

Original languageEnglish
Pages (from-to)20-25
Number of pages6
JournalInternational Journal of Cardiology
Volume259
DOIs
Publication statusPublished - May 15 2018

Keywords

  • Acute Coronary Syndrome/blood
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Non-ST Elevated Myocardial Infarction/blood
  • Percutaneous Coronary Intervention/trends
  • Platelet Activation/drug effects
  • Platelet Aggregation Inhibitors/pharmacology
  • Polymorphism, Genetic/genetics
  • Prospective Studies
  • Treatment Outcome

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    De Rosa, R., Palmerini, T., De Servi, S., Belmonte, M., Crimi, G., Cornara, S., Calabrò, P., Cattaneo, M., Maffeo, D., Toso, A., Bartorelli, A., Palmieri, C., De Carlo, M., Capodanno, D., Genereux, P., Angiolillo, D., Piscione, F., & Galasso, G. (2018). High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study. International Journal of Cardiology, 259, 20-25. https://doi.org/10.1016/j.ijcard.2018.01.057