| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2001;103:2572.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Point-of-Care Measured Platelet Inhibition Correlates With a Reduced Risk of an Adverse Cardiac Event After Percutaneous Coronary Intervention
Results of the GOLD (AU-Assessing Ultegra) Multicenter Study
From the Department of Cardiology, Wilford Hall Medical Center, San Antonio, Tex (S.R.S.); University of Arkansas, Little Rock (J.D.T., J.F.S.); the Carl and Edyth Lindner Research Center for Clinical Cardiovascular Research, Cincinnati, Ohio (D.J.K.); Wake Forest University School of Medicine, Winston-Salem, NC (G.A.B., D.C.S.); Duke Clinical Research Institute, Durham, NC (J.E.T.); Scripps Clinic, La Jolla, Calif (P.J.C., P.S.T.); Department of Cardiology (D.J.M., A.M.L.) and Department of Biostatistics and Epidemiology (G.J.), Cleveland Clinic Foundation, Cleveland, Ohio; Mother Francis Hospital, Tyler, Tex (F.I.N.); Mayo Clinic and Foundation, Rochester, Minn (P.B.B., D.R.H.); Brigham and Women’s Hospital, Boston, Mass (J.J.P.); Cardiovascular Research Foundation, Washington, DC (G.D.); and Montreal Heart Institute, Montreal, Canada (R.G., P.T.).
Correspondence to Steven R. Steinhubl, MD, Wilford Hall Medical Center, Department of Cardiology, 2200 Bergquist Dr, Lackland AFB, TX 78236. E-mail steven.steinhubl{at}59mdw.whmc.af.mil
Background—The optimal level of platelet inhibition with a glycoprotein (GP) IIb/IIIa antagonist necessary to minimize thrombotic complications in patients undergoing a percutaneous coronary intervention (PCI) is currently unknown.
Methods and
Results—Five hundred patients undergoing a PCI
with the planned use of a GP IIb/IIIa inhibitor had
platelet inhibition measured at 10 minutes, 1 hour, 8 hours, and 24
hours after the initiation of therapy with the Ultegra Rapid
Platelet Function Assay (Accumetrics). Major adverse cardiac events
(MACEs: composite of death, myocardial infarction, and urgent target
vessel revascularization) were prospectively
monitored, and the incidence correlated with the measured level of
platelet function inhibition at all time points. One quarter of all
patients did not achieve 
95% inhibition 10 minutes after the bolus
and experienced a significantly higher incidence of MACEs (14.4%
versus 6.4%, P=0.006).
Patients whose platelet function was <70% inhibited at 8 hours
after the start of therapy had a MACE rate of 25% versus 8.1% for
those 70% inhibited
(P=0.009). By
multivariate analysis, platelet function
inhibition 95% at 10 minutes after the start of therapy was
associated with a significant decrease in the incidence of a MACE (odds
ratio 0.46, 95% CI 0.22 to 0.96,
P=0.04).
Conclusions—Substantial variability in the level of platelet function inhibition is achieved with GP IIb/IIIa antagonist therapy among patients undergoing PCI. The level of platelet function inhibition as measured by a point-of-care assay is an independent predictor for the risk of MACEs after PCI.
Key Words: angioplasty • platelets • complications
This article has been cited by other articles:
 |
|
 |
|
  D. O. Williams and J. D. Abbott What to Do With Patients Receiving Long-Term Clopidogrel: Reload or Relax? Circulation, September 16, 2008; 118(12): 1219 - 1222. [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Douketis, P. B. Berger, A. S. Dunn, A. K. Jaffer, A. C. Spyropoulos, R. C. Becker, and J. Ansell The Perioperative Management of Antithrombotic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 299S - 339S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Kereiakes and P. A. Gurbel Peri-Procedural Platelet Function and Platelet Inhibition in Percutaneous Coronary Intervention J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 111 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. F. Storey Variability of response to antiplatelet therapy Eur. Heart J. Suppl., January 1, 2008; 10(suppl_A): A21 - A27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Gachet and B. Aleil Testing antiplatelet therapy Eur. Heart J. Suppl., January 1, 2008; 10(suppl_A): A28 - A34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. Gurbel, R. C. Becker, K. G. Mann, S. R. Steinhubl, and A. D. Michelson Platelet Function Monitoring in Patients With Coronary Artery Disease J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1822 - 1834. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Dobrzycki, P. Kralisz, K. Nowak, P. Prokopczuk, W. Kochman, J. Korecki, B. Poniatowski, J. Zuk, E. Sitniewska, H. Bachorzewska-Gajewska, et al. Transfer with GP IIb/IIIa inhibitor tirofiban for primary percutaneous coronary intervention vs. on-site thrombolysis in patients with ST-elevation myocardial infarction (STEMI): a randomized open-label study for patients admitted to community hospitals Eur. Heart J., October 2, 2007; 28(20): 2438 - 2448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Mahmud, J. J. Cavendish, S. Tsimikas, L. Ang, C. Nguyen, G. Bromberg-Marin, G. Schnyder, S. Keramati, V. Palakodeti, W. F. Penny, et al. Elevated Plasma Fibrinogen Level Predicts Suboptimal Response to Therapy With Both Single- and Double-Bolus Eptifibatide During Percutaneous Coronary Intervention J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2163 - 2171. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E.I. Levy, R. Mehta, R. Gupta, R.A. Hanel, A.J. Chamczuk, D. Fiorella, H.H. Woo, F.C. Albuquerque, T.G. Jovin, M.B. Horowitz, et al. Self-Expanding Stents for Recanalization of Acute Cerebrovascular Occlusions AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 816 - 822. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Campo, M. Valgimigli, D. Gemmati, G. Percoco, S. Tognazzo, G. Cicchitelli, L. Catozzi, P. Malagutti, M. Anselmi, C. Vassanelli, et al. Value of Platelet Reactivity in Predicting Response to Treatment and Clinical Outcome in Patients Undergoing Primary Coronary Intervention: Insights Into the STRATEGY Study J. Am. Coll. Cardiol., November 9, 2006; (2006) j.jacc.2005.12.085v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Alfonso and D. J. Angiolillo Platelet Function Assessment to Predict Outcomes After Coronary Interventions: Hype or Hope? J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1751 - 1754. [Full Text] [PDF]
|
|
|
|
|
|
W. Hochholzer, D. Trenk, H.-P. Bestehorn, B. Fischer, C. M. Valina, M. Ferenc, M. Gick, A. Caputo, H. J. Buttner, and F.-J. Neumann Impact of the Degree of Peri-Interventional Platelet Inhibition After Loading With Clopidogrel on Early Clinical Outcome of Elective Coronary Stent Placement J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1742 - 1750. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. N. Deliargyris, B. Upadhya, L. G. Melton, C. Thompson, M. Fisher, D. A. Gabriel, G. J. Dehmer, and D. C. Sane Unfractionated Heparin Reduces the Anti-Platelet Effects of Abciximab but not Eptifibatide During PCI. Clinical and Applied Thrombosis/Hemostasis, October 1, 2006; 12(4): 458 - 464. [Abstract] [PDF]
|
|
|
|
|
|
A. D. Michelson, A. L. Frelinger, and M. I. Furman Resistance to antiplatelet drugs Eur. Heart J. Suppl., October 1, 2006; 8(suppl_G): G53 - G58. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Bertrand and E. Van Belle Triple antiplatelet treatment in patients presenting with non-ST-segment elevation acute coronary syndromes Eur. Heart J. Suppl., October 1, 2006; 8(suppl_G): G59 - G63. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Hillman Platelet Aspirin Resistance Detection and Validation J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2565 - 2565. [Full Text] [PDF]
|
|
|
|
|
|
P. Patel, R. Gonzales, H. Dokainish, and N. Lakkis Impact of Adenosine Diphosphate and Calcium Chelation on Platelet Aggregation Testing in Patients Receiving Clopidogrel Therapy J. Am. Coll. Cardiol., January 17, 2006; 47(2): 464 - 465. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Sabatine, C. P. Cannon, C. M. Gibson, J. L. Lopez-Sendon, G. Montalescot, P. Theroux, B. S. Lewis, S. A. Murphy, C. H. McCabe, E. Braunwald, et al. Effect of Clopidogrel Pretreatment Before Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction Treated With Fibrinolytics: The PCI-CLARITY Study JAMA, September 14, 2005; 294(10): 1224 - 1232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Bates, W. C. Lau, and B. E. Bleske Loading, Pretreatment, and Interindividual Variability Issues With Clopidogrel Dosing Circulation, May 24, 2005; 111(20): 2557 - 2559. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Katori, F. Szlam, J. H. Levy, and K. A. Tanaka A Novel Method to Assess Platelet Inhibition by Eptifibatide with Thrombelastograph(R) Anesth. Analg., December 1, 2004; 99(6): 1794 - 1799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Michelson Platelet Function Testing in Cardiovascular Diseases Circulation, November 9, 2004; 110(19): e489 - e493. [Full Text] [PDF]
|
|
|
|
|
|
S. P. Schulman Antiplatelet Therapy in Non-ST-Segment Elevation Acute Coronary Syndromes JAMA, October 20, 2004; 292(15): 1875 - 1882. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M.S.K.J. Ernst, H. Suryapranata, K. Miedema, R. J. Slingerland, J. P. Ottervanger, J. C.A. Hoorntje, A.T.M. Gosselink, J.-H. E. Dambrink, M.-J. de Boer, F. Zijlstra, et al. Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1187 - 1193. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Patrono, B. Coller, G. A. FitzGerald, J. Hirsh, and G. Roth Platelet-Active Drugs: The Relationships Among Dose, Effectiveness, and Side Effects: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 234S - 264S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Gibson, L. K. Jennings, S. A. Murphy, D. P. Lorenz, R. P. Giugliano, R. A. Harrington, S. Cholera, R. Krishnan, R. M. Califf, E. Braunwald, et al. Association Between Platelet Receptor Occupancy After Eptifibatide (Integrilin) Therapy and Patency, Myocardial Perfusion, and ST-Segment Resolution Among Patients With ST-Segment-Elevation Myocardial Infarction: An INTEGRITI (Integrilin and Tenecteplase in Acute Myocardial Infarction) Substudy Circulation, August 10, 2004; 110(6): 679 - 684. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Valgimigli, G. Percoco, D. Barbieri, F. Ferrari, G. Guardigli, G. Parrinello, O. Soukhomovskaia, and R. Ferrari The additive value of tirofiban administered with the high-dose bolus in the prevention of ischemic complications during high-risk coronary angioplasty: The advance trial J. Am. Coll. Cardiol., July 7, 2004; 44(1): 14 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. I. Lev, D. Hasdai, E. Scapa, A. Tobar, A. Assali, J. Lahav, A. Battler, J. J. Badimon, and R. Kornowski Administration of eptifibatide to acute coronary syndrome patients receiving enoxaparin or unfractionated heparin: Effect on platelet function and thrombus formation J. Am. Coll. Cardiol., March 17, 2004; 43(6): 966 - 971. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Kunichika, O. Ben-Yehuda, S. Lafitte, N. Kunichika, B. Peters, and A. N. DeMaria Effects of glycoprotein iib/iiia inhibition on microvascular flow after coronary reperfusion: A quantitative myocardial contrast echocardiography study J. Am. Coll. Cardiol., January 21, 2004; 43(2): 276 - 283. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. C. Lau, P. A. Gurbel, P. B. Watkins, C. J. Neer, A. S. Hopp, D. G.M. Carville, K. E. Guyer, A. R. Tait, and E. R. Bates Contribution of Hepatic Cytochrome P450 3A4 Metabolic Activity to the Phenomenon of Clopidogrel Resistance Circulation, January 20, 2004; 109(2): 166 - 171. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Reiter, F. Mayr, H. Blazicek, E. Galehr, P. Jilma-Stohlawetz, H. Domanovits, and B. Jilma Desmopressin antagonizes the in vitro platelet dysfunction induced by GPIIb/IIIa inhibitors and aspirin Blood, December 15, 2003; 102(13): 4594 - 4599. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Chan, D. J. Moliterno, P. B. Berger, G. W. Stone, P. M. DiBattiste, S. L. Yakubov, S. K. Sapp, K. Wolski, D. L. Bhatt, E. J. Topol, et al. Triple antiplatelet therapy during percutaneous coronary intervention is associated withimproved outcomes including one-year survival: Results from the do tirofiban and reoprogive similar efficacy outcome trial (TARGET) J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1188 - 1195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Dupont, P. Fontana, C. Bachelot-Loza, J.-L. Reny, I. Bieche, F. Desvard, M. Aiach, and P. Gaussem An intronic polymorphism in the PAR-1 gene is associated with platelet receptor density and the response to SFLLRN Blood, March 1, 2003; 101(5): 1833 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Bertrand, M. L. Simoons, K. A.A. Fox, L. C. Wallentin, C. W. Hamm, E. McFadden, P. J. De Feyter, G. Specchia, and W. Ruzyllo Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation Eur. Heart J., December 1, 2002; 23(23): 1809 - 1840. [Full Text] [PDF]
|
|
|
|
|
|
R. Chun, B. A. Orser, and M. Madan Platelet Glycoprotein IIb/IIIa Inhibitors: Overview and Implications for the Anesthesiologist Anesth. Analg., October 1, 2002; 95(4): 879 - 888. [Full Text] [PDF]
|
|
|
|
|
|
W. B. Batchelor, T. R. Tolleson, Y. Huang, R. L. Larsen, R. M. Mantell, P. Dillard, M. Davidian, D. Zhang, W. J. Cantor, M. H. Sketch Jr, et al. Randomized COMparison of Platelet Inhibition With Abciximab, TiRofiban and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes: The COMPARE Trial Circulation, September 17, 2002; 106(12): 1470 - 1476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Bonz, B. Lengenfelder, J.o. Strotmann, S. Held, O. Turschner, K. Harre, C. Wacker, C. Waller, N. Kochsiek, M. Meesmann, et al. effect of additional temporary glycoprotein IIb/IIIa receptor inhibition on troponin release in elective percutaneous coronary interventions after pretreatment with aspirin and clopidogrel (TOPSTAR trial) J. Am. Coll. Cardiol., August 21, 2002; 40(4): 662 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Quinn, E. F. Plow, and E. J. Topol Platelet Glycoprotein IIb/IIIa Inhibitors: Recognition of a Two-Edged Sword? Circulation, July 16, 2002; 106(3): 379 - 385. [Full Text] [PDF]
|
|
|
|
|
|
D.J. Moliterno and E.J. Topol The TARGET trial: hit or miss? Eur. Heart J., June 1, 2002; 23(11): 835 - 837. [Full Text] [PDF]
|
|
|
|
|
|
G. W. Stone, D. J. Moliterno, M. Bertrand, F.-J. Neumann, H. C. Herrmann, E. R. Powers, C. L. Grines, J. W. Moses, D. J. Cohen, E. A. Cohen, et al. Impact of Clinical Syndrome Acuity on the Differential Response to 2 Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Coronary Stenting: The TARGET Trial* Circulation, May 21, 2002; 105(20): 2347 - 2354. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Galli Platelet Inhibition After Glycoprotein IIb/IIIa Inhibitor Therapy Circulation, December 18, 2001; 104 (25): e163 - e163. [Full Text] [PDF]
|
|
|
|
 |
|
 Low Platelet Inhibition Predicts Adverse Post-PCI Events Journal Watch Cardiology, August 3, 2001; 2001(803): 8 - 8. [Full Text]
|
|
|
|
|
|
K. K. Wu and J. T. Willerson Monitoring Platelet Function in Glycoprotein IIb/IIIa Inhibitor Therapy Circulation, May 29, 2001; 103(21): 2528 - 2530. [Full Text] [PDF]
|
|