Identification of platelet hyper-reactivity measured with a portable device immediately after percutaneous coronary intervention predicts in stent thrombosis

Abstract

Introduction Platelet hyper-reactivity, despite a standard anti-thrombotic therapy, is a recognized risk factor for recurrent myocardial ischemia and in-stent thrombosis following PCI. We have investigated whether this detrimental condition, measured by collagen–epinephrine closure times (CEPI-CT) with the Platelet Function Analyzer (PFA-100) device could predict IST defined as the composite of cardiovascular death or myocardial infarction. Materials and methods CEPI-CT was measured in 256 consecutive patients with stable angina ( n = 103) or ACS ( n = 153) 30 ± 8 h after PCI ( T 0) and 1 month later ( T 1). All patients were followed up for a mean period of 9 months. Platelet hyperactivity was defined as a CEPI-CT < 190 s. Results Baseline CEPI-CT < 190 s was associated with a higher rate of death or MI (LogRank χ 2 = 4.23, p = 0.039) as compared with CEPI-CT > 190 s (4.6% vs. 0.7%). Multivariable analysis after adjustment for other risk factors confirmed that baseline CEPI-CT < 190 s was an independent correlate for death or MI (Hazard ratio 6.981, p = 0.008). At T 1 there was a significant prolongation of CEPI-CT ( p = 0.03) from 208 ± 64 s to 240 ± 59 s but T 1 did not predict any event. Conclusions A CEPI-CT < 190 s measured within the first 24 h following PCI predicts IST defined as the occurrence of death or MI.