Predictive Value of Methods Measuring Platelet Activation for Ischemic Events in Patients Receiving Clopidogrel: A Systematic Review and Meta-analysis

2019 ◽  
Vol 24 (44) ◽  
pp. 5313-5333 ◽  
Author(s):  
Zhe Wang ◽  
Qiufen Xie ◽  
Qian Xiang ◽  
Yanjun Gong ◽  
Jie Jiang ◽  
...  
Keyword(s):  
Predictive Value ◽  
Light Transmission ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Light Transmission Aggregometry ◽  
Ischemic Events ◽  
Higher Sensitivity

This study investigates the efficiency and predictive value of light-transmission aggregometry (LTA), vasodilator-stimulated phosphoprotein (VASP) and VerifyNow for ischemia in patients undergoing percutaneous coronary intervention (PCI). Studies that used LTA, VASP or VerifyNow to predict ischemia were included, and their quality and efficiency were analyzed using Review Manager 5.3. The sensitivity and specificity of subgroup studies based on the outcome, cut-off value, and follow-up days were calculated and the summary ROC (sROC) curves were compared after having been fitted. Thirty-one studies including a total of 17,314 participants were analyzed. LTA, VASP and VerifyNow presented a considerable efficiency in predicting ischemic clinical events. In the subgroup analysis, the sensitivities of LTA, VASP and VerifyNow in predicting cardiac death, all-cause death, myocardial infarction, stent thrombosis, stroke, and revascularization were 0.40/0.63/0.62, 0.47/0.56/0.39, 0.40/0.48/0.60, 0.44/0.58/0.70, 0.29/not applicable/0.60 and 0.44/0.57/0.37, respectively and the specificities of LTA, VASP, and VerifyNow were 0.85/0.48/0.63, 0.73/0.52/0.63, 0.74/0.55/0.64, 0.75/0.47/0.61, 0.72/not applicable/ 0.61, and 0.70/0.47/0.67, respectively. LTA showed a higher sensitivity in predicting the outcomes over six months than those within six months, while VerifyNow prediction sensitivity was found to be higher within six months. Meanwhile, VerifyNow showed no statistically significant higher AUC of sROC in comparison to LTA and VASP in predicting ischemic events in patients undergoing clopidogrel treatment. The cut-off values of LTA, VASP and VerifyNow were suggested to be 56%, 50% and 235 respectively according to our study.

scholarly journals Long-Term Aspirin and Clopidogrel Response Evaluated by Light Transmission Aggregometry, VerifyNow, and Thrombelastography in Patients Undergoing Percutaneous Coronary Intervention

2010 ◽  
Vol 56 (5) ◽  
pp. 839-847 ◽  
Author(s):  
Esben Hjorth Madsen ◽  
Jacqueline Saw ◽  
Søren Risom Kristensen ◽  
Erik Berg Schmidt ◽  
Cheryl Pittendreigh ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Light Transmission ◽  
Coronary Intervention ◽  
Platelet Function Tests ◽  
Low Responders ◽  
Percutaneous Coronary ◽  
Light Transmission Aggregometry ◽  
Ischemic Events ◽  
Dual Treatment

Abstract Background: A reduced response to aspirin and clopidogrel predicts ischemic events, but reliable tests are needed to identify low responders. We compared 3 platelet-function tests during long-term dual treatment with aspirin and clopidogrel. Methods: Patients who underwent a percutaneous coronary intervention and were receiving a combination of 325 mg/day aspirin and 75 mg/day clopidogrel were followed for 1 year. Blood was sampled 5 times during this period for 3 tests: light transmission aggregometry (LTA) assay, with 5.0 μmol/L ADP or 1.0 mmol/L arachidonic acid (AA) used as an agonist; VerifyNow™ assay, with the P2Y12 or aspirin cartridge (Accumetrics); and thrombelastography (TEG), stimulated by 2.0 μmol/L ADP or 1.0 mmol/L AA. Results: Twenty-six of 33 patients completed all scheduled visits. A low response to clopidogrel was found in a few patients at variable frequencies and at different visits, depending on the method and criteria used. We found a moderate correlation between the LTA (ADP) and VerifyNow (P2Y12 cartridge) results, but the TEG (ADP) results correlated poorly with the LTA and VerifyNow results. A low response to aspirin was found with the VerifyNow (aspirin cartridge) and TEG (AA) methods on 6 and 2 occasions, respectively, but not with the LTA (AA) method, except for 1 occasion caused by probable noncompliance. Conclusions: Detecting a low response to clopidogrel depends largely on the method used. Which method best predicts ischemic events remains uncertain. A low response to aspirin is rare with AA-dependent methods used at the chosen cutoffs. In some patients, the response to clopidogrel or aspirin may be classified differently at different times, even with the same method.

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

scholarly journals Long-term prognosis of chronic total occlusion treated by successful percutaneous coronary intervention in patients with or without diabetes mellitus: a systematic review and meta-analysis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yong Zhu ◽  
Shuai Meng ◽  
Maolin Chen ◽  
Kesen Liu ◽  
Ruofei Jia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Percutaneous Coronary Intervention ◽  
Chronic Total Occlusion ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
Long Term Prognosis

Abstract Background Diabetes mellitus (DM) is highly prevalent among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Therefore, the purpose of our study was to investigate the clinical outcomes of CTO-PCI in patients with or without DM. Methods All relevant articles published in electronic databases (PubMed, Embase, and the Cochrane Library) from inception to August 7, 2020 were identified with a comprehensive literature search. Additionally, we defined major adverse cardiac events (MACEs) as the primary endpoint and used risk ratios (RRs) with 95% confidence intervals (CIs) to express the pooled effects in this meta-analysis. Results Eleven studies consisting of 4238 DM patients and 5609 non-DM patients were included in our meta-analysis. For DM patients, successful CTO-PCI was associated with a significantly lower risk of MACEs (RR = 0.67, 95% CI 0.55–0.82, p = 0.0001), all-cause death (RR = 0.46, 95% CI 0.38–0.56, p < 0.00001), and cardiac death (RR = 0.35, 95% CI 0.26–0.48, p < 0.00001) than CTO-medical treatment (MT) alone; however, this does not apply to non-DM patients. Subsequently, the subgroup analysis also obtained consistent conclusions. In addition, our study also revealed that non-DM patients may suffer less risk from MACEs (RR = 1.26, 95% CI 1.02–1.56, p = 0.03) than DM patients after successful CTO-PCI, especially in the subgroup with a follow-up period of less than 3 years (RR = 1.43, 95% CI 1.22–1.67, p < 0.0001). Conclusions Compared with CTO-MT alone, successful CTO-PCI was found to be related to a better long-term prognosis in DM patients but not in non-DM patients. However, compared with non-DM patients, the risk of MACEs may be higher in DM patients after successful CTO-PCI in the drug-eluting stent era, especially during a follow-up period shorter than 3 years.

scholarly journals Impact of depression on clinical outcomes following percutaneous coronary intervention: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e026445 ◽  
Author(s):  
Wen Yi Zhang ◽  
Nan Nan ◽  
Xian Tao Song ◽  
Jin Fan Tian ◽  
Xue Yao Yang
Keyword(s):  
Systematic Review ◽  
Percutaneous Coronary Intervention ◽  
Meta Analysis ◽  
Positive Association ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Assessment Time

ObjectivesThe objective of this meta-analysis was to assess whether depression in percutaneous coronary intervention (PCI) patients is associated with higher risk of adverse outcomes.DesignSystematic review and meta-analysis.MethodsEMBASE, PubMed, CINAHL and PsycINFO were searched as data sources. We selected prospective cohort studies evaluating the relationship between depression and any adverse medical outcome, including all-cause mortality, cardiac mortality and non-fatal events, from inception to 28 February 2019. Two reviewers independently extracted information and calculated the risk of cardiovascular events in patients with preoperative or postoperative depression compared with non-depressed patients.ResultsEight studies (n=3297) met our inclusion criteria. Most studies found a positive association between depression and adverse cardiovascular outcomes. Meta-analysis yielded an aggregate risk ratio of 1.57 (95% CI 1.28 to 1.92, p<0.0001) for the magnitude of the relation between depression and adverse outcomes.ConclusionsOur systematic review and meta-analysis suggests that depression is associated with an increased risk of worse clinical outcome or mortality in patients undergoing PCI. Assessment time and length of follow-up do not have a significant effect on this conclusion.

scholarly journals Percutaneous coronary intervention versus medical therapy for chronic total coronary occlusions: a systematic review and meta-analysis of randomised trials

2020 ◽  
Vol 29 (1) ◽  
pp. 30-41 ◽  
Author(s):  
A. van Veelen ◽  
J. Elias ◽  
I. M. van Dongen ◽  
L. P. C. Hoebers ◽  
B. E. P. M. Claessen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Left Ventricular ◽  
Randomised Trials ◽  
Percutaneous Coronary

Abstract Background The results of chronic total occlusion percutaneous coronary intervention (CTO-PCI) trials are inconclusive. Therefore, we studied whether CTO-PCI leads to improvement of clinical endpoints and patient symptoms when combining all available randomised data. Methods and results This meta-analysis was registered in PROSPERO prior to starting. We performed a literature search and identified all randomised trials comparing CTO-PCI to optimal medical therapy alone (OMT). A total of five trials were included, comprising 1790 CTO patients, of whom 964 were randomised to PCI and 826 to OMT. The all-cause mortality was comparable between groups at 1‑year [risk ratio (RR) 1.70, 95% confidence interval (CI) 0.50–5.80, p = 0.40] and at 4‑year follow-up (RR 1.14, 95% CI 0.38–3.40, p = 0.81). There was no difference in the incidence of major adverse cardiac events (MACE) between groups at 1 year (RR 0.69, 95% CI 0.36–1.33, p = 0.27) and at 4 years (RR 0.85, 95% CI 0.60–1.22, p = 0.38). Left ventricular function and volumes at follow-up were comparable between groups. However, the PCI group had fewer target lesion revascularisations (RR 0.28, 95% CI 0.15–0.52, p < 0.001) and was more frequently free of angina at 1‑year follow-up (RR 0.65, 95% CI 0.50–0.84, p = 0.001), although the scores on the subscales of the Seattle Angina Questionnaire were comparable. Conclusion In conclusion, in this meta-analysis of 1790 CTO patients, CTO-PCI did not lead to an improvement in survival or in MACE as reported at long-term follow-up of up to 4 years, or to improvement of left ventricular function. However, CTO-PCI resulted in less angina and fewer target lesion revascularisations compared to OMT.

P2552Triple vs. double antithrombotic therapy in patients needing oral anticoagulation undergoing percutaneous coronary intervention: a meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Errigo ◽  
A Saglietto ◽  
F Angelini ◽  
G Y H Lip ◽  
R D Lopes ◽  
...  
Keyword(s):  
Major Bleeding ◽  
Antithrombotic Therapy ◽  
Meta Analysis ◽  
Antiplatelet Agent ◽  
Coronary Intervention ◽  
Secondary Outcome ◽  
Therapy Strategy ◽  
Percutaneous Coronary ◽  
Neutral Effect

Abstract Background The optimal antithrombotic therapy strategy in patients undergoing PCI who need OAC is currently debated. Purpose To determine the best regimen in terms of safety and efficacy. Methods We performed a meta-analysis of RCT and adjusted results reporting outcomes of patients who underwent PCI and were on TT or DAPT or DT. All-cause death was the primary end point, while MACE was the secondary outcome, along with its individual components, and major bleedings. Results 15 studies encompassing 27070 patients were included. After a follow up of 12 (11–14) months, TT reduced all-cause death compared to DAPT (OR 0.52, 0.35–0.78), mainly driven by a lower incidence of MI (OR 0.81, 0.69–0.85) and stroke (OR 0.76, 0.56–1.03) despite higher rates of major bleedings (OR 2.81, 1.54–5.12). Comparing TT vs. DT with warfarin, all-cause death was non-significantly different (OR 1.23, 0.60–2.53), nor MI (OR 0.77, 0.23–2.59) and stroke (OR 4.01, 0.80–20.07), while major bleeding was increased with TT (OR 2.40, 1.34–4.38). When compared to DT with NOACs, TT did not reduce risk of MI (OR 0.96, 0.67–1.36) or stroke (OR 0.82, 0.55–1.24), but increased major bleedings (OR 1.98, 1.43–2.73). The non-randomized comparison between DT with warfarin and DT with NOACs showed a neutral effect on death and major bleedings, with similar rates also of MI (OR 0.47, 0.20–1.11, all CI 95%). Conclusion Double therapy with warfarin or with NOAC plus a single antiplatelet agent reduces the risk of major bleeding compared to triple therapy, with a neutral impact of subsequent ischemic events.

Platelet aggregation in response to ADP is highly variable in normal donors and patients on anti-platelet medication

2016 ◽  
Vol 54 (7) ◽  
Author(s):  
Eimear Dunne ◽  
Karl Egan ◽  
Siobhán McFadden ◽  
David Foley ◽  
Dermot Kenny
Keyword(s):  
Platelet Aggregation ◽  
Therapeutic Response ◽  
Light Transmission ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
P2y12 Inhibitors ◽  
Aggregation Response ◽  
Healthy Donors ◽  
Percutaneous Coronary ◽  
Light Transmission Aggregometry

AbstractP2Y12 inhibitors are indicated in patients following percutaneous coronary intervention. Several studies have demonstrated that high on treatment platelet reactivity is correlated with outcomes yet prospective studies of guided therapy have failed to show benefit. There is a paucity of studies on the platelet aggregation response to ADP before P2Y12 therapy is started. The aim of this study was to characterize platelet responses to 20 μM ADP by light transmission aggregometry (LTA) in a homogenous population.Platelet aggregation was assessed in 201 patients on dual antiplatelet therapy, 98 patients on aspirin alone and 47 normal, healthy volunteers free from anti-platelet medication.Consensus guidelines suggest that a platelet aggregation response in response to the agonist ADP of <57% is an adequate therapeutic response to P2Y12 inhibition. Seven healthy donors and 38 patients taking aspirin only had aggregation responses below 57%.The results of our study demonstrate that 15% of normal donors and 38% of patients taking aspirin only would be classified as having a therapeutic response to P2Y12 inhibition using current guidelines.

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