Efficacy of Predicting Thrombotic Events with Combination of Dual Point-of-Care Testing (POCT) after Drug-Eluting Stent Implantation for Coronary Heart Disease: Results from the CILON-T Randomized Trial POCT Substudy
Efficacy of Predicting Thrombotic Events with Combination of Dual Point-of-Care Testing (POCT) after Drug-Eluting Stent Implantation for Coronary Heart Disease: Results from the CILON-T Randomized Trial POCT Substudy
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DOI：
10.5551/jat.9290
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发表时间：
2011-01-01
影响因子：
4.4
通讯作者：
Kim, Hyo-Soo
中科院分区：
文献类型：
--
作者：
Lee, Seung-Pyo;Park, Kyung Woo;Kim, Hyo-Soo
目的：先前关于治疗中血小板反应性的研究集中在对单个抗血小板药物的反应变异性上。关于[1]对这两种抗血小板药物的反应变异性，[2]同时结合两种床旁检测（POCT）的有效性以及[3]如何预测经皮冠状动脉介入治疗（PCI）后的临床结局的数据有限。我们分析了716例患者，入组了CILON-T前瞻性随机对照试验，出院时使用VerifyNow P2 Y12（PRU）和阿司匹林（ARU）数据。根据PRU、ARU的三分位数以及PRU和ARU的三分位数之和对患者进行分类。主要终点是心源性死亡，非致命性心肌梗死（MI）和缺血性卒中的复合物在6个月后PCI.Results：10例患者达到主要终点，其中4例是非致命性MI和6例缺血性卒中。当分析主要终点时，ARU和PRU的三分位数不能区分未来发生血栓形成事件的患者与其余患者（ARU和PRU的对数秩检验分别为p = 0.197和0.058），而ARU和PRU的三分位数组合则显著有效（ARU+PRU的对数秩检验为p = 0.019）。多变量分析显示，ARU和PRU三分位数总和的最高三分位数是PCI术后未来血栓事件的唯一显著预测因素（HR 6.34，95%置信区间1.32-30.47，p = 0.021）。在CILON-T试验的事后分析中，同时结合ARU和PRU的结果，与单独检测相比，在区分PCI后血栓事件风险最高的患者方面具有重要作用。
Aim: Previous studies regarding on-treatment platelet reactivity have focused on response variability to individual antiplatelet agents. There are limited data on [1] response variability to both of these anti-platelet drugs, [2] efficacy of combining two point-of-care tests (POCT) simultaneously and [3] how it predicts the clinical outcome after percutaneous coronary intervention (PCI).Methods: We analyzed 716 patients, enrolled in the CILON-T prospective randomized controlled trial, with both VerifyNow P2Y12 (PRU) and Aspirin (ARU) data at discharge. Patients were classified according to the tertile of PRU, ARU and the sum of the tertiles of PRU and ARU. The primary endpoint was the composite of cardiac death, nonfatal myocardial infarction (MI) and ischemic stroke at 6 months post-PCI.Results: Ten patients reached the primary endpoint, four of which were nonfatal MI and six ischemic stroke. When analyzed for the primary endpoint, tertiles of ARU and PRU were not able to discriminate patients with future thrombotic events from the remainder (p = 0.197 for ARU and 0.058 for PRU with the log-rank test, respectively), whereas combining the tertiles of ARU and PRU was significantly effective (p = 0.019 for ARU+PRU with the log-rank test). Multivariate analysis showed that the highest tertile of the sum of ARU and PRU tertiles was the only significant predictor of future thrombotic events after PCI (HR 6.34, 95% confidence interval 1.32-30.47, p = 0.021).Conclusions: In this post-hoc analysis of the CILON-T trial, combining the results of ARU and PRU simultaneously had a significant role in discriminating patients at highest risk of future thrombotic events after PCI compared with either assay alone.