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POPULAR: Platelet reactivity tests predicted ischemic events in patients undergoing PCI
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American Heart Association Scientific Sessions 2009
Three antiplatelet therapy response tests identified patients at high-risk for clot-related complications in patients undergoing PCI plus stent implantation, according to data from the POPULAR study.
“This is the first head-to-head comparison of multiple platelet function tests in predicting thrombotic and bleeding events in patients undergoing elective PCI. However, none of the tests we used were able to identify patients at higher risk for TIMI major and minor bleeding,” Nicoline J. Breet, MD, fellow and cardiologist-in-training at St. Antonius Hospital in the Netherlands, said during a presentation.
The researchers set out to compare eight platelet reactivity tests (light transmittance aggregometry 5 umol/L ADP and 20 umol/L ADP, VerifyNow P2Y12, Plateletworks, Impact-R, Impact-R ADP, PFA-100 COL/ADP and Innovance PFA P2Y) in 1,069 consecutive patients undergoing elective PCI with stent implantation treated with clopidogrel.
Mean age of the study population was 64 years; 74% were men. Approximately 36% of patients were treated with bare-metal stents and 64% treated with DES. Follow-up was one year.
A significant difference was found for patients with and without platelet inhibition at year one for three tests (light transmittance aggregometry, VerifyNow P2Y12 and Plateletworks) (12.1% vs. 6%).
Logistic regression modeling utilizing clinical factors alone indentified an area under the curve of 0.64 in predicting one-year primary endpoint — this increased to 0.72 when procedural risk factors were added.
Further, when the researchers added platelet reactivity, a significant increase was found in area under the curve for both light transmittance aggregometry, VerifyNow P2Y12 and Plateletworks. However, the absolute area under the curve was only modestly increased (0.74, 0.73, 0.74 and 0.78, respectively). – by Jennifer Southall
For more information:
- N Breet. #91. Presented at: the American Heart Association 2009 Annual Scientific Meeting; Nov. 14-18; Orlando, Fla.
The POPULAR study is the largest, carefully controlled, head-to- head comparison study conducted thus far, which enables us to assess the predictive impact on clinical outcome. Unfortunately, there was no discrimination in bleeding events; this is an issue which is important with the availability of antiplatelet drugs.
– Dietmar Trenk, PhD
Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
