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. 2015 Mar 23;10(3):e0121620.
doi: 10.1371/journal.pone.0121620. eCollection 2015.

Evaluation of clinical risk factors to predict high on-treatment platelet reactivity and outcome in patients with stable coronary artery disease (PREDICT-STABLE)

Michal Droppa  1 , Dimitri Tschernow  1 , Karin A L Müller  1 , Elli Tavlaki  1 , Athanasios Karathanos  1 , Fabian Stimpfle  1 , Elke Schaeffeler  2 , Matthias Schwab  3 , Alexander Tolios  4 , Jolanta M Siller-Matula  5 , Meinrad Gawaz  1 , Tobias Geisler  1
Affiliations

Evaluation of clinical risk factors to predict high on-treatment platelet reactivity and outcome in patients with stable coronary artery disease (PREDICT-STABLE)

Michal Droppa et al. PLoS One. .

Abstract

Objectives: This study was designed to identify the multivariate effect of clinical risk factors on high on-treatment platelet reactivity (HPR) and 12 months major adverse events (MACE) under treatment with aspirin and clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI).

Methods: 739 consecutive patients with stable coronary artery disease (CAD) undergoing PCI were recruited. On-treatment platelet aggregation was tested by light transmittance aggregometry. Clinical risk factors and MACE during one-year follow-up were recorded. An independent population of 591 patients served as validation cohort.

Results: Degree of on-treatment platelet aggregation was influenced by different clinical risk factors. In multivariate regression analysis older age, diabetes mellitus, elevated BMI, renal function and left ventricular ejection fraction were independent predictors of HPR. After weighing these variables according to their estimates in multivariate regression model, we developed a score to predict HPR in stable CAD patients undergoing elective PCI (PREDICT-STABLE Score, ranging 0-9). Patients with a high score were significantly more likely to develop MACE within one year of follow-up, 3.4% (score 0-3), 6.3% (score 4-6) and 10.3% (score 7-9); odds ratio 3.23, P=0.02 for score 7-9 vs. 0-3. This association was confirmed in the validation cohort.

Conclusions: Variability of on-treatment platelet function and associated outcome is mainly influenced by clinical risk variables. Identification of high risk patients (e.g. with high PREDICT-STABLE score) might help to identify risk groups that benefit from more intensified antiplatelet regimen. Additional clinical risk factor assessment rather than isolated platelet function-guided approaches should be investigated in future to evaluate personalized antiplatelet therapy in stable CAD-patients.

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Conflict of interest statement

Competing Interests: JS-M received research grants from Roche, personal fees from Astra Zeneca, Daiichy Sankyo, Eli Lilly, outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. There are no conflicts of interest to declare on behalf of the other contributing authors.

Figures

Fig 1
Fig 1. A Incidence of HPR (%) according to PREDICT-STABLE Score B Incidence of MACE according to PREDICT-STABLE Score.
P-values for comparison with PREDICT-STABLE score 0–3
Fig 2
Fig 2. Kaplan-Meier analysis for incidence of MACE according PREDICT-STABLE Score (comparison of score levels 0–3 with 7–9).
Fig 3
Fig 3. Kaplan-Meier analysis for incidence of MACE according platelet function analysis (comparison of HPR vs. adequate on-treatment response in Patients with high PREDICT-STABLE Score 7–9).
Fig 4
Fig 4. Comparison of predictive value for on-treatment platelet reactivity (PR), PREDICT-STABLE Score alone and in combination by ROC curve analysis.
Fig 5
Fig 5. A Incidence of MACE according to PREDICT-STABLE Score in the validation cohort B Platelet reactivity assessed by MEA according to PREDICT-STABLE Score in the validation cohort.
P-values for comparison with PREDICT-STABLE score 0–3.
See this image and copyright information in PMC

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