High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study

Roberta De Rosa, Tullio Palmerini, Stefano De Servi, Marta Belmonte, Gabriele Crimi, Stefano Cornara, Paolo Calabrò, Marco Cattaneo, Diego Maffeo, Anna Toso, Antonio Bartorelli, Cataldo Palmieri, Marco De Carlo, Davide Capodanno, Philippe Genereux, Dominick Angiolillo, Federico Piscione, Gennaro Galasso

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI. Methods: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel. Major adverse cardiac events (MACE) were assessed up to 1 year-follow-up. Results: Elderly with HPR at discharge showed a significantly higher incidence of overall MACE (13 vs 4%, p =.006), cardiac death (6 vs 0.7%, p =.020), myocardial infarction (MI, 12 vs 4%, p =.031) and a trend for higher stent-thrombosis (5 vs 0.7%, p =.068). Similarly, elderly with 1-month-HPR showed between 1 month and 1 year significantly higher incidence of MACE (10 vs 4%, p =.012), cardiac death (6 vs 0.7%, p =.019) and composite cardiac death/MI (11 vs 4%, p =.014). Up to 1 year, elderly with HPR showed a 4-fold increased risk of MACE compared to both elderly without HPR (for discharge-HPR: p =.005; for 1-month-HPR: p =.01) and non-elderly with HPR (for discharge-HPR: p <.001; for 1-month-HPR: p <.0001). At multivariable analysis, HPR could independently predict 1-year-MACE in elderly (for discharge-HPR: HR = 3.191, CI: 1.373–7.417, p =.007; for 1-month-HPR: HR = 3.542, CI: 1.373–9.137, p =.009). Conclusions: In elderly with NSTE-ACS undergoing PCI and treated with clopidogrel, HPR was independently associated with an increased risk of MACE up to 1 year.

Original languageEnglish (US)
Pages (from-to)20-25
Number of pages6
JournalInternational Journal of Cardiology
Volume259
DOIs
StatePublished - May 15 2018

Fingerprint

Acute Coronary Syndrome
Blood Platelets
clopidogrel
Percutaneous Coronary Intervention
Therapeutics
Incidence
Stents
Thrombosis
Myocardial Infarction
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

De Rosa, Roberta ; Palmerini, Tullio ; De Servi, Stefano ; Belmonte, Marta ; Crimi, Gabriele ; Cornara, Stefano ; Calabrò, Paolo ; Cattaneo, Marco ; Maffeo, Diego ; Toso, Anna ; Bartorelli, Antonio ; Palmieri, Cataldo ; De Carlo, Marco ; Capodanno, Davide ; Genereux, Philippe ; Angiolillo, Dominick ; Piscione, Federico ; Galasso, Gennaro. / High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study. In: International Journal of Cardiology. 2018 ; Vol. 259. pp. 20-25.
@article{b8f911ba43924f209d687626bc491c8a,
title = "High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study",
abstract = "Background: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI. Methods: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel. Major adverse cardiac events (MACE) were assessed up to 1 year-follow-up. Results: Elderly with HPR at discharge showed a significantly higher incidence of overall MACE (13 vs 4{\%}, p =.006), cardiac death (6 vs 0.7{\%}, p =.020), myocardial infarction (MI, 12 vs 4{\%}, p =.031) and a trend for higher stent-thrombosis (5 vs 0.7{\%}, p =.068). Similarly, elderly with 1-month-HPR showed between 1 month and 1 year significantly higher incidence of MACE (10 vs 4{\%}, p =.012), cardiac death (6 vs 0.7{\%}, p =.019) and composite cardiac death/MI (11 vs 4{\%}, p =.014). Up to 1 year, elderly with HPR showed a 4-fold increased risk of MACE compared to both elderly without HPR (for discharge-HPR: p =.005; for 1-month-HPR: p =.01) and non-elderly with HPR (for discharge-HPR: p <.001; for 1-month-HPR: p <.0001). At multivariable analysis, HPR could independently predict 1-year-MACE in elderly (for discharge-HPR: HR = 3.191, CI: 1.373–7.417, p =.007; for 1-month-HPR: HR = 3.542, CI: 1.373–9.137, p =.009). Conclusions: In elderly with NSTE-ACS undergoing PCI and treated with clopidogrel, HPR was independently associated with an increased risk of MACE up to 1 year.",
author = "{De Rosa}, Roberta and Tullio Palmerini and {De Servi}, Stefano and Marta Belmonte and Gabriele Crimi and Stefano Cornara and Paolo Calabr{\`o} and Marco Cattaneo and Diego Maffeo and Anna Toso and Antonio Bartorelli and Cataldo Palmieri and {De Carlo}, Marco and Davide Capodanno and Philippe Genereux and Dominick Angiolillo and Federico Piscione and Gennaro Galasso",
year = "2018",
month = "5",
day = "15",
doi = "10.1016/j.ijcard.2018.01.057",
language = "English (US)",
volume = "259",
pages = "20--25",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

De Rosa, R, Palmerini, T, De Servi, S, Belmonte, M, Crimi, G, Cornara, S, Calabrò, P, Cattaneo, M, Maffeo, D, Toso, A, Bartorelli, A, Palmieri, C, De Carlo, M, Capodanno, D, Genereux, P, Angiolillo, D, Piscione, F & Galasso, G 2018, 'High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study', International Journal of Cardiology, vol. 259, pp. 20-25. https://doi.org/10.1016/j.ijcard.2018.01.057

High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study. / De Rosa, Roberta; Palmerini, Tullio; De Servi, Stefano; Belmonte, Marta; Crimi, Gabriele; Cornara, Stefano; Calabrò, Paolo; Cattaneo, Marco; Maffeo, Diego; Toso, Anna; Bartorelli, Antonio; Palmieri, Cataldo; De Carlo, Marco; Capodanno, Davide; Genereux, Philippe; Angiolillo, Dominick; Piscione, Federico; Galasso, Gennaro.

In: International Journal of Cardiology, Vol. 259, 15.05.2018, p. 20-25.

Research output: Contribution to journalArticle

TY - JOUR

T1 - High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study

AU - De Rosa, Roberta

AU - Palmerini, Tullio

AU - De Servi, Stefano

AU - Belmonte, Marta

AU - Crimi, Gabriele

AU - Cornara, Stefano

AU - Calabrò, Paolo

AU - Cattaneo, Marco

AU - Maffeo, Diego

AU - Toso, Anna

AU - Bartorelli, Antonio

AU - Palmieri, Cataldo

AU - De Carlo, Marco

AU - Capodanno, Davide

AU - Genereux, Philippe

AU - Angiolillo, Dominick

AU - Piscione, Federico

AU - Galasso, Gennaro

PY - 2018/5/15

Y1 - 2018/5/15

N2 - Background: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI. Methods: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel. Major adverse cardiac events (MACE) were assessed up to 1 year-follow-up. Results: Elderly with HPR at discharge showed a significantly higher incidence of overall MACE (13 vs 4%, p =.006), cardiac death (6 vs 0.7%, p =.020), myocardial infarction (MI, 12 vs 4%, p =.031) and a trend for higher stent-thrombosis (5 vs 0.7%, p =.068). Similarly, elderly with 1-month-HPR showed between 1 month and 1 year significantly higher incidence of MACE (10 vs 4%, p =.012), cardiac death (6 vs 0.7%, p =.019) and composite cardiac death/MI (11 vs 4%, p =.014). Up to 1 year, elderly with HPR showed a 4-fold increased risk of MACE compared to both elderly without HPR (for discharge-HPR: p =.005; for 1-month-HPR: p =.01) and non-elderly with HPR (for discharge-HPR: p <.001; for 1-month-HPR: p <.0001). At multivariable analysis, HPR could independently predict 1-year-MACE in elderly (for discharge-HPR: HR = 3.191, CI: 1.373–7.417, p =.007; for 1-month-HPR: HR = 3.542, CI: 1.373–9.137, p =.009). Conclusions: In elderly with NSTE-ACS undergoing PCI and treated with clopidogrel, HPR was independently associated with an increased risk of MACE up to 1 year.

AB - Background: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI. Methods: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel. Major adverse cardiac events (MACE) were assessed up to 1 year-follow-up. Results: Elderly with HPR at discharge showed a significantly higher incidence of overall MACE (13 vs 4%, p =.006), cardiac death (6 vs 0.7%, p =.020), myocardial infarction (MI, 12 vs 4%, p =.031) and a trend for higher stent-thrombosis (5 vs 0.7%, p =.068). Similarly, elderly with 1-month-HPR showed between 1 month and 1 year significantly higher incidence of MACE (10 vs 4%, p =.012), cardiac death (6 vs 0.7%, p =.019) and composite cardiac death/MI (11 vs 4%, p =.014). Up to 1 year, elderly with HPR showed a 4-fold increased risk of MACE compared to both elderly without HPR (for discharge-HPR: p =.005; for 1-month-HPR: p =.01) and non-elderly with HPR (for discharge-HPR: p <.001; for 1-month-HPR: p <.0001). At multivariable analysis, HPR could independently predict 1-year-MACE in elderly (for discharge-HPR: HR = 3.191, CI: 1.373–7.417, p =.007; for 1-month-HPR: HR = 3.542, CI: 1.373–9.137, p =.009). Conclusions: In elderly with NSTE-ACS undergoing PCI and treated with clopidogrel, HPR was independently associated with an increased risk of MACE up to 1 year.

UR - http://www.scopus.com/inward/record.url?scp=85044132565&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85044132565&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2018.01.057

DO - 10.1016/j.ijcard.2018.01.057

M3 - Article

VL - 259

SP - 20

EP - 25

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -