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Thienopyridine Therapy Influences Late Outcome After Coronary Stent Implantation

Department of Interventional Cardiology, Heart Institute, University of Pécs

Attila Kónyi, MD

Department of Interventional Cardiology, Heart Institute, University of Pécs

László Pálinkás, MD

Institute of Immunbiology and Immuntechnology University of Pécs, Pécs, Hungary

Tímea Berki, MD, PhD

Institute of Immunbiology and Immuntechnology University of Pécs, Pécs, Hungary

Tünde Pintér, MD

Department of Interventional Cardiology, Heart Institute, University of Pécs

Tamás Tahin, MD

Department of Interventional Cardiology, Heart Institute, University of Pécs

Iván Horváth, MD

Department of Interventional Cardiology, Heart Institute, University of Pécs

Lajos Papp, MD, DSc

Department of Interventional Cardiology, Heart Institute, University of Pécs

András Komócsi, MD, PhD

Department of Interventional Cardiology, Heart Institute, University of Pécs, andras.komocsi{at}aok.pte.hu

Clinical significance of resistance to aspirin and thienopyridine therapy is poorly defined. The authors aimed to evaluate whether more effective antiplatelet therapy is associated with better outcome in patients on dual-antiplatelet treatment. Using optical aggregometer, maximal platelet aggregation values were measured with induction of adenosine diphosphate, collagen, and adrenaline 30 ± 5 days after coronary stent implantation in 134 patients. Markers of platelet activation were also analyzed with fluorescent immunoassay in 57 patients. After 10 months of follow-up, 33 patients reached the composite endpoint of cardiovascular death, myocardial infarction, and revascularisation. Adenosine diphosphate-induced maximal aggregation values were in significant relationship with the development of major adverse cardiac events (P < .01). Level of soluble P-selectin proved to be an independent risk factor of adverse outcome (P < .05). As efficacy of thienopyridine therapy showed significant relation with clinical outcome, the authors conclude that interindividual variability in response to adenosine diphosphate-receptor antagonists may be of substantial clinical importance.

Key Words: antiplatelet agents and therapy • optical aggregometry • direct stent implantation • prognosis

This version was published on May 1, 2008

Angiology, Vol. 59, No. 2, 172-178 (2008)
DOI: 10.1177/0003319707304572


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