1. Evaluation of clinical risk factors to predict high on-treatment platelet reactivity and outcome in patients with stable coronary artery disease (PREDICT-STABLE).
- Author
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Droppa M, Tschernow D, Müller KA, Tavlaki E, Karathanos A, Stimpfle F, Schaeffeler E, Schwab M, Tolios A, Siller-Matula JM, Gawaz M, and Geisler T
- Subjects
- Age Factors, Aged, Body Mass Index, Coronary Artery Disease blood, Diabetes Complications, Female, Humans, Kidney Function Tests, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Platelet Aggregation drug effects, Platelet Aggregation Inhibitors therapeutic use, Platelet Function Tests, ROC Curve, Regression Analysis, Risk Factors, Stents adverse effects, Thrombosis prevention & control, Treatment Outcome, Coronary Artery Disease surgery, Percutaneous Coronary Intervention adverse effects, Postoperative Complications epidemiology, Thrombosis epidemiology
- Abstract
Objectives: This study was designed to identify the multivariate effect of clinical risk factors on high on-treatment platelet reactivity (HPR) and 12 months major adverse events (MACE) under treatment with aspirin and clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI)., Methods: 739 consecutive patients with stable coronary artery disease (CAD) undergoing PCI were recruited. On-treatment platelet aggregation was tested by light transmittance aggregometry. Clinical risk factors and MACE during one-year follow-up were recorded. An independent population of 591 patients served as validation cohort., Results: Degree of on-treatment platelet aggregation was influenced by different clinical risk factors. In multivariate regression analysis older age, diabetes mellitus, elevated BMI, renal function and left ventricular ejection fraction were independent predictors of HPR. After weighing these variables according to their estimates in multivariate regression model, we developed a score to predict HPR in stable CAD patients undergoing elective PCI (PREDICT-STABLE Score, ranging 0-9). Patients with a high score were significantly more likely to develop MACE within one year of follow-up, 3.4% (score 0-3), 6.3% (score 4-6) and 10.3% (score 7-9); odds ratio 3.23, P=0.02 for score 7-9 vs. 0-3. This association was confirmed in the validation cohort., Conclusions: Variability of on-treatment platelet function and associated outcome is mainly influenced by clinical risk variables. Identification of high risk patients (e.g. with high PREDICT-STABLE score) might help to identify risk groups that benefit from more intensified antiplatelet regimen. Additional clinical risk factor assessment rather than isolated platelet function-guided approaches should be investigated in future to evaluate personalized antiplatelet therapy in stable CAD-patients.
- Published
- 2015
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