ABSTRACT
BACKGROUND: Decreased responsiveness to oral antiplatelet drug therapy has been associated with an adverse outcome after coronary stenting (CS), but more studies are needed. The purpose of the present study was to prospectively evaluate this issue. METHODS: A total of 612 consecutive patients with stable or unstable coronary artery disease who underwent CS after at least 12 hours of aspirin and clopidogrel loading were studied. The study population was divided into responders and nonresponders to oral antiplatelet therapy, according to the values of preprocedural Platelet Function Analyzer-100 (Dade Behring, Marburg, Germany) collagen epinephrine closure time (CEPI-CT). In particular, responders were considered as patients with a CEPI-CT > 193 seconds and nonresponders as those with a CEPI-CT < or = 193 seconds. The 1-year incidence of the composite of cardiac death and rehospitalization for nonfatal myocardial infarction was the prespecified primary study end point. RESULTS: At 1 year, 9.1% of patients reached the primary end point. Nonresponders to oral antiplatelet therapy were at significantly higher risk for the primary end point (18.7% vs 7.6%) than responders. Nonresponsiveness to oral antiplatelet therapy was a predictor of the primary end point by both univariate (hazard ratio 2.7, 95% CI 1.6-4.5, P < .001) and multivariate (hazard ratio 2.5, 95% CI 1.6-3.8, P < .001) Cox regression analysis. CONCLUSION: Based on the present data, preprocedural responsiveness to oral antiplatelet therapy, assessed by Platelet Function Analyzer-100 CEPI-CT, is an independent predictor of long-term outcome after CS.
Subject(s)
Aspirin/therapeutic use , Myocardial Infarction/therapy , Platelet Aggregation Inhibitors/therapeutic use , Stents , Ticlopidine/analogs & derivatives , Aged , Aspirin/pharmacokinetics , Clopidogrel , Coronary Angiography , Creatine Kinase, MB Form/blood , Drug Therapy, Combination , Drug Tolerance , Female , Hospitalization/statistics & numerical data , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Myocardial Infarction/mortality , Myocardial Infarction/prevention & control , Platelet Aggregation Inhibitors/pharmacokinetics , Prognosis , Prospective Studies , Secondary Prevention , Ticlopidine/pharmacokinetics , Ticlopidine/therapeutic useSubject(s)
Diabetes Mellitus, Type 1/epidemiology , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Angioplasty, Balloon, Coronary/methods , Combined Modality Therapy , Comorbidity , Coronary Angiography , Coronary Artery Bypass/methods , Diabetes Mellitus, Type 1/diagnosis , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/epidemiology , Diabetic Angiopathies/therapy , Female , Fibrinolytic Agents/therapeutic use , Humans , Male , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/etiology , Prognosis , Risk Assessment , Severity of Illness Index , Stents , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: High plasma C-reactive protein (CRP) levels have been associated with an unfavorable outcome in patients with coronary artery disease (CAD), and a direct participation of CRP in the atherosclerotic process has been postulated. HYPOTHESIS: The aim of this study was to evaluate the possible relationship of high plasma CRP levels with the rapid progression of coronary atherosclerosis (RPCAD). METHODS: In all, 194 patients who were readmitted and underwent repeat coronary angiography because of recurrence of symptoms following successful percutaneous coronary intervention were studied. Median angiographic follow-up time was 6 months. Rapid progression CAD was defined as the presence of a new lesion, > 25% in luminal diameter stenosis, in a previously nondiseased vessel, or deterioration of a known, nontreated lesion by at least 25%. RESULTS: By multivariate analysis, patients with high plasma CRP levels upon first admission were at higher risk of RPCAD. In particular, odds ration (OR) = 1.8; 95% confidence interval (CI) = 1.3-3.6; p value = 0.02 in patients with CRP = 0.5-2 mg/dl versus patients with CRP < 0.5 mg/dl, and OR = 7.1; 95% CI = 3.8-9.5; p value < 0.001 in patients with CRP > 2 mg/dl versus patients with CRP < 0.5 mg/dl. CONCLUSION: Increased plasma CRP levels could possibly identify patients at high risk for the development of RPCAD.
Subject(s)
C-Reactive Protein/analysis , Coronary Disease/blood , Aged , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/therapy , Disease Progression , Female , Humans , Male , Middle Aged , Multivariate Analysis , Risk Assessment , Risk FactorsABSTRACT
OBJECTIVES: The objective of this study was to evaluate the association of high plasma levels of either C-reactive protein (CRP), lipoprotein (a) (Lp[a]) or total homocysteine (tHCY) with the long-term prognosis after successful coronary stenting (CS). BACKGROUND: High plasma levels of either CRP, Lp(a) or tHCY may have an impact in coronary artery disease. However, long-term prospective data after coronary stenting (CS) are limited. METHODS: Four-hundred and eighty-three consecutive patients with either stable or unstable coronary syndromes were followed for up to three years after successful CS. The composite of cardiac death, myocardial infarction or rehospitalization for rest unstable angina, whichever occurred first, was the prespecified primary end point. Moreover, the one-year incidence of clinical recurrence of symptoms, in-stent restenosis (ISR) and progression of atherosclerosis to a significant lesion (PTSL) were additionally evaluated. PTSL was defined as an increase by at least 25% in the luminal diameter stenosis of a known nonsignificant lesion (