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The Residual Platelet Aggregation after Deployment of Intracoronary Stent (PREDICT) score
Author(s) -
GEISLER T.,
GRAß D.,
BIGALKE B.,
STELLOS K.,
DROSCH T.,
DIETZ K.,
HERDEG C.,
GAWAZ M.
Publication year - 2008
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2007.02812.x
Subject(s) - medicine , clopidogrel , renal function , diabetes mellitus , cardiology , incidence (geometry) , acute coronary syndrome , cohort , population , aspirin , myocardial infarction , endocrinology , physics , environmental health , optics
Summary. Background: Recent studies suggest a high interindividual variability of response to clopidogrel associated with adverse cardiovascular outcome. Different clinical factors are considered to influence a persistent residual platelet aggregation (RPA) despite conventional antiplatelet therapy. Objectives: To investigate clinical factors that affect RPA after 600‐mg clopidogrel loading in a large unselected cohort of patients with symptomatic CAD. Methods: The study population included a consecutive cohort of 1092 patients treated with coronary stenting for stable angina and acute coronary syndromes (ACS). Residual platelet activity was assessed by ADP (20 μmol L −1 )‐induced platelet aggregation ≥ 6 h after LD. Eleven clinical factors were included in the primary analysis. Results: In multivariate regression analysis increased RPA was significantly influenced by ACS, reduced LV‐function, diabetes mellitus, renal failure (creatinine > 1.5 mg dL −1 ), and age > 65 years. In a factor‐weighed model the risk for high RPA increased with higher score levels (OR for patients with a score of 1–3, 1.21, 95% CI 0.7–2.1; score 4–6, OR 2.0, 95% CI 1.17–3.5; P = 0.01; score 7–9, OR 3.3, 95% CI 1.8–6.0). During a 30‐day follow‐up the incidence of major adverse events was higher in patients with RPA in the upper tertile (4.8% vs. 2.5% in the 2nd and 1.5% in the 1st tertile; P < 0.05). Conclusions: The PREDICT score provides a good tool to estimate residual platelet activity after clopidogrel LD by easily available patient details. Additionally, we demonstrate its association with short‐term outcome. Thus, patients with a high score may benefit from intensified antiplatelet therapy by improved platelet inhibition and risk reduction for thromboischemic events.