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Low response to clopidogrel independently predictive of CV death

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Low platelet response to clopidogrel was indicative of CV events, including death, in a high-risk population undergoing percutaneous coronary intervention, study findings suggested.

The prospective study consisted of 461 patients who were undergoing urgent (n=346) or planned (n=115) PCI. Researchers categorized patients as low response and response to clopidogrel, depending on their platelet reactivity index (PRI). They determined optimal PRI cutoff by receiver-operator characteristic curve analysis to 61% (Low response=PRI ≥61%; response=PRI <61%).

At a mean follow-up of 9 ± 2 months obtained in 453 patients (98.3%), total cardiac mortality rates and possible and total stent thrombosis were higher in low-response patients. After multivariate analysis, researchers identified the following as independent predictors of cardiac death: creatinine clearance (HR=0.95; 95% CI, 0.93-0.98), drug-eluting stent (HR=5.73; 95% CI, 1.40-23.43), CRP (HR=1.01; 95% CI, 1.001-1.019) and low response to clopidogrel (HR=4.00; 95% CI, 1.08-14.80). Additionally, researchers found that low response to clopidogrel on CV death was higher in those implanted with a drug-eluting stent.

“The results of the present prospective registry suggest that low responsiveness to clopidogrel is an independent predictor of all-cause mortality, cardiovascular death, and possible and total stent thrombosis after PCI,” the researchers wrote.

Sotirios Tsimikas, MD, and Gregor Leibundgut, MD, of the University of California San Diego and the University Hospital Basel in Switzerland, respectively, commented in an accompanying editorial about the study’s implications, stating it “adds to the rapidly growing observational study database on post-clopidogrel platelet hyporesponsiveness and clinical outcomes.”

El Ghannudi S. J Am Coll Cardiol Intv. 2010;3:648-656.

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