Author + information
- Received August 23, 2011
- Accepted September 5, 2011
- Published online December 13, 2011.
- Duk-Woo Park, MD⁎,
- Seung-Whan Lee, MD⁎,
- Sung-Cheol Yun, PhD†,
- Hae-Geun Song, MD⁎,
- Jung-Min Ahn, MD⁎,
- Jong-Young Lee, MD⁎,
- Won-Jang Kim, MD⁎,
- Soo-Jin Kang, MD⁎,
- Young-Hak Kim, MD⁎,
- Cheol Whan Lee, MD⁎,
- Seong-Wook Park, MD⁎ and
- Seung-Jung Park, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Seung-Jung Park, Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea
Objectives This study sought to investigate clinical utility of on-site platelet function test and C-reactive protein (CRP) in patients undergoing percutaneous coronary intervention (PCI).
Background Data on long-term prognostic value of high on-treatment platelet reactivity (HTPR) on clopidogrel after PCI are limited. As a distinct biological pathway, CRP has been suggested to be associated with post-PCI atherothrombotic events.
Methods We evaluated 2,849 patients who received drug-eluting stents (DES) and had post-PCI VerifyNow P2Y12 assays (Accumetrics, San Diego, California) performed. Among them, baseline CRP measurement was available in 2,546 patients. The primary endpoint was a composite of all-cause death, nonfatal myocardial infarction, stent thrombosis, and stroke.
Results During follow-up (median, 2.2 years), the occurrence of the primary endpoint did not significantly differ among patients with and without HTPR (2.8% vs. 2.4% at 2 years; hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 0.88 to 2.01; p = 0.18). By contrast, patients with elevated CRP levels were at significantly higher risk for the primary endpoint, as compared with those with nonelevated CRP levels (5.6% vs. 1.7% at 2 years; HR: 2.81, 95% CI:, 1.83 to 4.31; p < 0.001). The VerifyNow test had no incremental usefulness to classify long-term risk. However, the incorporation of CRP into a model with conventional clinical and procedural risk factors significantly improved the C-statistic for the prediction of the primary endpoint (0.729 to 0.759; p = 0.03).
Conclusions We failed to identify that HTPR measured by VerifyNow P2Y12 assay was significantly associated with long-term atherothrombotic risks in patients receiving DES. However, elevated CRP levels were significantly associated with worse outcomes and had incremental predictive values over conventional risk factors.
This study was partly supported by the Cardiovascular Research Foundation, Seoul, Korea, and by a grant from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Korea (A102065).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. D.-W. Park and S.-W. Lee contributed equally to this work.
- Received August 23, 2011.
- Accepted September 5, 2011.
- American College of Cardiology Foundation