PLATELET INDICES ARE NOT ASSOCIATED WITH OCCURRENCE OF PERIPROCEDURAL MYOCARDIAL INFARCTION IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY ANGIOPLASTY

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IL TRATTAMENTO DELLE DISLIPIDEMIE NELLA PREVENZIONE PRIMARIA DELLE MALATTIE CARDIOVASCOLARI: LE INDICAZIONI PER LA PRATICA CLINICA

Le dislipidemie rappresentano uno dei più importanti fattori causali della arteriosclerosi e delle sue complicanze d’organo, come l’infarto del miocardico, l’ictus e la vasculopatia periferica. Il loro appropriato trattamento rappresenta la base degli interventi di prevenzione primaria delle malattie cardiovascolari su base ischemica. In generale, per dislipidemia si intende una condizione clinica nella quale sono presenti alterazioni qualitative e/o quantitative dei lipidi e delle lipoproteine plasmatiche

High platelet reactivity and periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention: A significant association beyond definitions

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Comparison of platelet reactivity and periprocedural outcomes in patients with versus without diabetes mellitus and treated with clopidogrel and percutaneous coronary intervention

The effect of periprocedural platelet reactivity and clinical outcomes in diabetic patients taking clopidogrel and undergoing percutaneous coronary intervention (PCI) is unclear. The aim of the present study was to prospectively evaluate the influence of diabetes mellitus (DM) on platelet reactivity measured by the VerifyNow P2Y12 assay and on periprocedural outcomes in patients receiving clopidogrel and undergoing PCI. A total of 285 consecutive clopidogrel-treated patients undergoing elective PCI were included. Platelet function analysis was performed using the VerifyNow P2Y12 assay. High platelet reactivity (HPR) after clopidogrel was defined as a platelet reaction unit value > or =240. Cardiac biomarkers were measured before and 8 and 24 hours after intervention. Patients with DM had significantly higher platelet reactivity before PCI compared to nondiabetics (214 +/- 83 vs 193 +/- 68 platelet reaction units, p = 0.02). HPR was more frequently observed in diabetics (36% vs 22%, p = 0.01) before PCI. Patients with DM had an increased incidence of periprocedural myocardial infarction (MI; 11% vs 4%, p = 0.04). When the entire population was divided by the presence or absence of DM and HPR, patients with DM and HPR presented the highest incidence of periprocedural MI (p for trend = 0.0008). HPR was an independent predictor of periprocedural MI (odds ratio 8.34, 95% confidence interval 2.60 to 26.76, p = 0.0003). In conclusion, patients with DM undergoing PCI have higher platelet reactivity at the time of PCI despite adequate clopidogrel pretreatment and subsequently worse periprocedural outcomes. Point-of-care platelet function testing may help to identify patients at higher risk of periprocedural MI

Comparison among patients ≥75 years having percutaneous coronary angioplasty using drug-eluting stents versus bare metal stents

Limited data are available on long-term efficacy and safety of drug-eluting stents (DES) in elderly patients who underwent PCI. A total of 635 consecutive patients aged ≥75 years who underwent PCI were enrolled at 2 European centers. Of these, 170 patients received at least 1 DES, whereas 465 patients received bare metal stent (BMS) only. Primary end point was the incidence of net adverse clinical events (NACE), defined as the occurrence of ischemic events or bleeding events, and was compared at a median follow-up of 31.2 months. Clinical follow-up information was available in 593 patients (93.4%). The duration of dual antiplatelet therapy was 12.3 ± 5.1 months in the DES group and 3.8 ± 7.4 months in the BMS group. The Kaplan-Meier estimate of NACE at 5 years was significantly lower in DES-treated patients (40.5%) than in BMS-treated patients (55.7%; p = 0.009). This benefit was driven by a significant reduction in myocardial infarction (8.6% vs 16.6%; p = 0.038) and target vessel revascularization rates (7.9% vs 21.9%; p = 0.003) in the DES group, with no significant increase in the incidence of bleeding events (13.8% vs 12.2%; p = 0.882). These results were confirmed at propensity score-adjusted Cox proportional hazard analysis. In conclusion, in patients ≥75 years, the use of DES compared with BMS seems to reduce myocardial infarction and repeat revascularization rates at long-term follow-up, without an increase in bleeding despite longer duration of dual antiplatelet therapy. This net clinical benefit, resulting from persistent efficacy and safety over time, may support the use of DES as a reasonable option in patients ≥75 years. © 2015 Elsevier Inc. All rights reserved

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

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