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KMID : 0368120090390120512
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Korean Circulation Journal
2009 Volume.39 No. 12 p.512 ~ p.518
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The Significance of Clopidogrel Low-Responsiveness on Stent Thrombosis and Cardiac Death Assessed by the Verifynow P2Y12 Assay in Patients With Acute Coronary Syndrome Within 6 Months After Drug-Eluting Stent Implantation
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Lee Kyoung-Hoon
Kim Seong-Yoon
Kim Jang-Young
Youn Young-Jin
Choe Kyung-Hoon
Lee Seung-Whan
Ahn Min-Soo
Yoo Byung-Su
Yoon Jung-Han
Lee Jun-Won
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Abstract
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Background and Objectives : Clopidogrel resistance or low-responsiveness may be associated with recurrent atherothrombotic events after drug-eluting stent (DES) implantation. We prospectively evaluated the association between clopidogrel resistance assessed by the Verifynow™ P2Y12 assay (Accumetrics, San Diego, CA, USA) and stent thrombosis (ST) or cardiac death (CD) in patients with acute coronary syndrome (ACS) within 6 months after DES implantation.
Subjects and Method : We enrolled 237 consecutive patients (160 males, 65.2±10.3 years) with ACS who received a DES implantation. The composite endpoint was defined to CD or ST by Academic Research Consortium definitions within 6 months post-implantation. Clopidogrel resistance was defined as <20% inhibition of the P2Y12 receptor.
Results: Baseline demographic characteristics were similar between 142 normal individuals and 95 clopidogrel resistant patients. CD occurred in one case (0.7%) in the normal group and two cases (2.13%) in the resistant group (p=0.344). There was no episode of ST in the normal group and four episodes in the resistant group (4.2%, four definite ST) (p=0.035). Univariate logistic regression revealed an adjusted odds ratio (OR) for composite end point of CD or ST of 9.646 {95% confidence interval (CI) 1.139-81.679}, and multivariate logistic regression for composite end point revealed an OR of 12.074 (95% CI 1.205-120.992).
Conslusion: Clopidogrel low-responsiveness assessed by the Verifynow™ P2Y12 assay is an independent predictor of ST and composite end point of ST or CD in patients with ACS within 6 months after DES implantation.
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KEYWORD
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Thienopyridine, Platelets, Clopidogrel, Thrombosis, Stents
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