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Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
Topic:

Theme Issue
Platelet function testing: From bench to bedside

DOI: http://dx.doi.org/10.1160/TH11-02-0077
Issue: 2011: 106/2 (Aug) pp. 185-387
Pages: 230-239

Multiple electrode aggregometry and vasodilator stimulated phosphoprotein-phosphorylation assay in clinical routine for prediction of postprocedural major adverse cardiovascular events

M. K. Freynhofer (1, 2), I. Brozovic (1), V. Bruno (1, 3), S. Farhan (1), B. Vogel (1), G. Jakl (1), M. Willheim (4), W. Hübl (4), J. Wojta (2, 5), K. Huber (1, 2)

(1) 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria; (2) Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; (3) Department of Obstetrics and Gynecology, Wilhelminenhospital, Vienna, Austria; (4) Department of Laboratory Medicine, Wilhelminenhospital, Vienna, Austria; (5) Department of Cardiology, Medical University of Vienna, Vienna, Austria

Summary

Reduced antiplatelet effect of clopidogrel assessed with multiple electrode aggregometry (MEA) and vasodilator stimulated phosphoprotein-phosphorylation (VASP-P) assay has been proven to predict major adverse cardiovascular events (MACE) after coronary stenting. So far no consecutive registry has evaluated the usefulness of different adenosine diphosphate-based platelet function tests to predict outcome in unselected patients. Hence, our objective was to determine the feasibility of MEA and VASP-P for clinical routine and whether low-response to clopidogrel as determined by MEA and/or the VASP-P assays predicts MACE in a “real-life” population undergoing coronary stenting. Three-hundred consecutive patients were included in this prospective registry. Blood was sampled 6–24 hours after stenting to measure MEA and VASP-P. The use of glycoprotein-IIb/IIIa-blockers limited MEA to 196 measurements. Concerning the VASP-P assay, 300 measurements were achieved. Receiver Operating Characteristics (ROC)-curves of sensitivity and specificity estimates for MACE were plotted for VASP-P assay. The area under the ROC-curve was 0.683 (p=0.014) for the platelet reactivity index (PRI) calculated from median fluorescence intensities (FI) with an optimal cut-off at 60.2% PRI. Patients above 60.2% had a significantly increased risk for MACE at six months follow-up (p=0.007). Estimating the cut-offs for the PRI from mean FI (52%) or from geometric mean FI (56.6%) led to clinically relevant differences. VASP-P assay is feasible for clinical routine to measure clopidogrel effects and to predict post-procedural MACE in unselected patients. With regard to differing cut-offs, exact standardisation of the VASP-P assay is mandatory. The use of GP-IIb/IIIa-blockers prevents MEA testing and limits its usability in unselected patients.

Keywords

clopidogrel, High on-treatment platelet reactivity, platelet function testing, prospective registry

DOI

http://dx.doi.org/10.1160/TH11-02-0077

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