Prognostic value of platelet reactivity, inflammatory markersand genotyping in coronary artery disease patientsafter percutaneous coronary intervention
Authors:
Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery; Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
Keywords: coronary artery stenting platelet aggregation stent thrombosis stent restenosis inflammatory markers PAI-1 von Willebrand factor polymorphism CYP2C19 dual antiplatelet therapy
Abstract
Objective: The aim of our study is to evaluate high on-treatment platelet reactivity and also prognostic impact of various inflammatory markers levels on clinical outcomes based on genetic background of patients after percutaneous coronary intervention. Material and methods. In our study we included 94 patients with stable coronary artery disease during 2009–2013. All patients scheduled to perform percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation were taking dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. To assess the on-treatment platelet response we used the “classical” light trancemittance agregometry with 5 μmol/L ADPand also a new, fully automated method – VerifyNow. In this study we assess baseline levels of different inflammatory markers: level of hs-C-reactive protein (CRP), soluble P-selectin, soluble CD40L, hs-IL-6, level of PAI-1 and von Willebrand factor activity before PCI. All patients were genotyped to define the presence of CYP2C19*2 polymorphism after discharging from hospital. Results. We have found following risk factors for adverse events after PCI with DES implantation: diabetes mellitus, PRU, number of stented arteries, number of implanted stents, the initial level of PAI-1 and von Willebrand factor (vWF) activity. According to the results of our study, it was found that diabetes is an independent predictor of adverse outcomes after PCI [exp(B) 10.299; 95% confidence inteval (CI) 1.236–85.850; p=0.03]. Also PRU (according to the VerifyNow) was found to be an independent predictor of adverse outcome after PCI [exp(B) 1.016; 95% CI, 1.002–1.030; p=0.03]. Significant independent impact was found for the level of PAI-1 and vWF activity before PCI [exp(B) 0.999; 95% CI, 0.999–1.000; p=0.01 and exp(B) 1.000; 95% CI, 1.000–1.000; p=0.045]. Conclusion. Concomitant diabetes mellitus, high platelet reactivity (according to VerifyNow), as well as higher initial level of PAI-1 and von Willebrand factor activity is an independent predictor of adverse cardiac events after PCI with implantation of drug-eluting stents. Light transmittance agregatometry with 5 μmol/L ADP have no significant prognostic impact on clinical outcomes after PCI. Developed predictive models will identify patients with high risk for adverse outcomes after PCI and optimize management of these patients before and after PCI.References
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