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KMID : 0882420090760060685
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Korean Journal of Medicine
2009 Volume.76 No. 6 p.685 ~ p.691
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Clinical impact of aspirin resistance measured using the Ultegra Rapid Platelet Function Assay-ASA in patients undergoing percutaneous coronary intervention
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Yim Ji-Hye
Kim Young-Hak
Lee Cheol-Whan
Park Seung-Jung
Choi Hyung-Oh
Park Duk-Woo
Hong Myeong-Ki
Lee Pil-Hyung
Sun Byung-Joo
Kim Jae-Joong
Park Seong-Wook
Lee Seung-Whan
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Abstract
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Background/Aims: Aspirin resistance is reported to be associated with myocardial infarction, stroke, and myonecrosis after percutaneous coronary intervention. However, aspirin resistance and its clinical implications in patients undergoing drug-eluting stent (DES) implantation have not been evaluated sufficiently.
Methods: The study enrolled 419 consecutive patients who underwent DES implantation. All of the patients took aspirin 100 mg (228 patients, 54.4%) or 200 mg (191 patients, 45.6%). Aspirin resistance was measured using the Ultegra Rapid Platelet Function Assay-ASA (Accumetrics, San Diego, CA, USA). The results were expressed as aspirin reaction units (ARU). Aspirin resistance was defined as ARU ≥550. We followed all patients for 9 months.
Results: Aspirin resistance was found in 33 patients (33/419, 7.9%). The aspirin dose (118.18±39.2 vs. 147.93±50.0 mg, p=0.011) was lower in the aspirin-resistant (n=33) versus the aspirin-sensitive (n=386) group. There was no significant difference in the occurrence of myocardial necrosis (15.6% vs. 15.5%, p=0.988). On multivariate analysis, low-dose aspirin (odds ratio (OR) 4.714; 95% confidence interval (CI) 1.865-11.914; p=0.001), age (OR 1.048; 95% CI 1.005-0.092, p=0.029), platelet count (OR 1.007; 95% CI 1.001-1.014, p=0.011), and hypercholesterolemia (OR 2.937; 95% CI 1.310-6.583, p=0.009) were independent predictors of aspirin resistance. Over the 9 months, no stent thrombosis or death occurred; one acute myocardial infarction occurred in the aspirin-sensitive group.
Conclusions: Low-dose aspirin, old age, a higher platelet count, and hypercholesterolemia were associated with a high incidence of aspirin resistance in patients who underwent DES implantation. However, no significant differences in clinical outcome were found between the aspirin-resistant and -sensitive groups during a 9-month follow-up.
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KEYWORD
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Aspirin resistance, Stent, Coronary artery disease
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