Correlation of high post-treatment platelet reactivity assessed by light transmittance aggregometry and the VerifyNow P2Y12 assay

Abstract

In vitro "high post-treatment platelet reactivity" (HPPR) measured with light transmittance aggregometry (LTA) and the VerifyNow P2Y(12) assay has been associated with an increased risk of ischemic events after percutaneous coronary intervention (PCI). However, there are many criteria for HPPR according to the methods used for assessment, and correlations among suggested criteria have not been evaluated. To this end, we enrolled 1,058 unselected patients undergoing PCI in real clinical practice, simultaneously assessed platelet measures with LTA (both 5 and 20μmol/l ADP-induced) and the VerifyNow P2Y(12) assay, and based on previous studies, evaluated the following criteria for HPPR: 5 or 20μmol/l ADP-induced maximal platelet reactivity (PR(max)) ≥50%; 5μmol/l ADP-induced late PR (PR(late)) >14%; 20μmol/l ADP-induced PR(max) ≥62%; and P2Y(12) reaction unit (PRU) ≥240. Receiver-operating characteristics (ROC) curve analysis demonstrated that PRU (cut-off=241) distinguished between patients with and without 5μmol/l ADP-induced PR(max) ≥50% (area under curve [AUC] 0.822, sensitivity 83.0%, specificity 66.0%, P<0.001), and 20μmol/l ADP-induced PR(max) ≥62% (AUC 0.840, sensitivity 80.7%, specificity 71.4%, P<0.001), respectively. PRU ≥240 showed a moderate agreement with 5μmol/l ADP-induced PR(max) ≥50% (κ=0.438, concordant rate 71.6%, P<0.001) and 20μmol/l ADP-induced PR(max) ≥62% (κ=0.505, concordant rate 75.1%, P<0.001). Cut-offs matched for 20μmol/l ADP-induced PR(max) ≥50% (PRU=195) and 5μmol/l ADP-induced PR(late) >14 (PRU=194) also were similar. The presence of significant correlations between the suggested criteria for HPPR has practical implications on the possible use of the VerifyNow P2Y(12) assay for risk stratification in PCI-treated patients.