Highlights
- •While the predictive value of HTPR for PCI is known no data are available for CAS.
- •300 patients undergoing CAS were enrolled in a prospective clinical study.
- •HTPR to DAPT was evaluated with 5 different laboratory assays.
- •HTPR detected by MEA and VASP test was associated with risk of MACE.
- •HTPR to three tests was strongly predictive of increased MACE risk.
Abstract
Background and purpose
High-on-treatment platelet reactivity (HTPR) has been established as a predictor of
major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary
interventions on dual antiplatelet therapy (DAPT), but no data are available on its
predictive value in patients on DAPT after carotid artery stenting (CAS). We aimed
to evaluate the possible association between HTPR in patients on aspirin plus clopidogrel
therapy after CAS and subsequent MACE.
Methods
All consecutive patients treated with CAS in a single institution were enrolled in
a prospective clinical study. HTPR was evaluated with 5 different laboratory assays
carried out just before CAS. MACE incidence (cerebral ischemia, myocardial infarction,
stent thrombosis, acute limb ischemia and vascular death) was evaluated at 30 days
and thereafter at yearly visits.
Results
A total of 300 patients were enrolled in the study, and eight were then excluded because
blood samples resulted unsuitable for the laboratory testing or CAS aborted for technical
problems. Median follow-up was 5.8 years and during this period 47 MACE occurred.
HTPR detected by multiplate electronic aggregometry (MEA) and the VASP phosphorylation
assay (VASP) were associated with a significantly enhanced risk of MACE (p = 0.048
and p = 0.038, respectively). However, HTPR to three tests (HTPR3) was more strongly
predictive of increased risk of a vascular event at follow up (p = 0.005) at bivariate
analysis and also at Cox regression multivariate analysis (p = 0.002).
Conclusions
HTPR to three different assays (mainly to VASP + PFA P2Y+ VerifyNow) in patients on
DAPT after CAS has predictive value for subsequent MACE. Prospective studies to assess
whether platelet function testing-guided antiplatelet therapy is superior to standard
DAPT in patient undergoing CAS should be considered.
Keywords
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Article info
Publication history
Published online: December 27, 2022
Accepted:
December 22,
2022
Received in revised form:
December 15,
2022
Received:
August 31,
2022
Identification
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