| Long-term clinical outcome based on aspirin and clopidogrel responsiveness status after elective percutaneous coronary intervention: a 3T/2R (tailoring treatment with tirofiban in patients showing resistance to aspirin and/or resistance to clopidogrel) trial substudy. | |
| | |
MedLine Citation:
|
PMID: 20951320 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVES: The purpose of this study was to investigate the long-term outcome after elective percutaneous coronary intervention in low-risk patients screened for aspirin and/or clopidogrel responsiveness in the 3T/2R (Tailoring Treatment With Tirofiban in Patients Showing Resistance to Aspirin and/or Resistance to Clopidogrel) trial. BACKGROUND: The impact of aspirin and/or clopidogrel poor response on long-term outcome is debated. METHODS: Aspirin and clopidogrel response was measured with the VerifyNow system aspirin and P2Y12 assays. After percutaneous coronary intervention (PCI), death, stroke, and myocardial infarction were assessed up to 1 year. RESULTS: Overall, 1,277 patients were screened, and 826 (65%) were treated with PCI. In all, 124 patients were found to be aspirin poor responders, and there were 179 clopidogrel poor responders (totally, 278 poor responders). The 1-year end point was significantly higher in poor responders as compared to full responders (15.8% vs. 8.6%, p=0.002), which is principally due to more myocardial infarction occurrence. At multivariable analysis, clopidogrel poor response emerged as an independent predictor (hazard ratio: 1.15, 95% confidence interval: 1.03 to 1.28). Receiver-operator characteristic analysis identifies≤23 of percentage of platelet inhibition and ≥208 of P2Y12 reactivity units as optimal cut offs to predict 1-year end point. Excluding periprocedural events, also peri-PCI myocardial infarction, which is strongly related to aspirin/clopidogrel poor response, was an independent predictor (hazard ratio: 1.25, 95% confidence interval: 1.14 to 1.37). Glycoprotein IIb/IIIa inhibitor administration reduces this risk in poor responders (21.2% vs. 34.7%, p=0.02), but not in full responders (6.3% vs. 6.5%, p=0.8). CONCLUSIONS: Poor response to clopidogrel is an independent predictor of periprocedural myocardial infarction and worse 1-year outcome in low-risk patients undergoing PCI, whereas poor response to aspirin failed to predict a worse outcome. Contrary to what was observed in poor responders, glycoprotein IIb/IIa inhibitor therapy failed to provide a benefit in aspirin and/or clopidogrel full responders. |
| | |
Authors:
|
Gianluca Campo; Luca Fileti; Nicoletta de Cesare; Emanuele Meliga; Alessandro Furgieri; Filippo Russo; Salvatore Colangelo; Salvatore Brugaletta; Roberto Ferrari; Marco Valgimigli; |
Publication Detail:
|
Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Journal of the American College of Cardiology Volume: 56 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2010 Oct |
Date Detail:
|
Created Date: 2010-10-18 Completed Date: 2010-11-02 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
|
Languages: eng Pagination: 1447-55 Citation Subset: AIM; IM |
Copyright Information:
|
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
|
Cardiovascular Institute, AOU S. Anna, Ferrara, Italy. cmpglc@unife.it |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Aged, 80 and over Angioplasty, Transluminal, Percutaneous Coronary / trends* Aspirin / therapeutic use* Drug Resistance* Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction / mortality, prevention & control Predictive Value of Tests Prospective Studies Surgical Procedures, Elective / trends* Ticlopidine / analogs & derivatives*, therapeutic use Time Factors Treatment Outcome Tyrosine / analogs & derivatives*, therapeutic use |
| Chemical | |
Reg. No./Substance:
|
144494-65-5/tirofiban; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 55520-40-6/Tyrosine; 90055-48-4/clopidogrel |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Medical and surgical treatment of acute right ventricular failure.
Next Document: Prevention of atrial fibrillation recurrence with corticosteroids after radiofrequency catheter abla...