Comparison of Platelet Function Guided Versus Unguided Treatment With P2Y12 Inhibitors in Patients With Acute Myocardial Infarction (from the Hungarian Myocardial Infarction Registry)

A. Komócsi, Dániel Aradi, Tibor Szűk, Gergely György Nagy, Ebrahim Noori, Zoltán Ruzsa, R. Kiss, Péter Andrássy, Lajos Nagy, Ferenc Tamás Nagy, Géza Lupkovics, Zsolt Kőszegi, Csaba András Dézsi, E. Papp, Zsolt Molnár, Péter Kupó, Péter Ofner, B. Merkely, A. Jánosi

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Abstract

Evidence is conflicting regarding the clinical benefits of selecting P2Y12 inhibitors based on platelet function testing (PFT). Between March 1, 2013 and March 1, 2014, we collected clinical characteristics and platelet function data in a nationwide acute myocardial infarction (AMI) registry from 15 interventional cardiology centers in Hungary. The risk of all-cause mortality at 1 year were compared after propensity score (PS) matching between patients receiving PFT-guided and unguided P2Y12-inhibitor therapies. High platelet reactivity on clopidogrel (HPRoC) was uniformly defined with the Multiplate assay. A total of 5,583 patients with AMI and coronary intervention were registered. After exclusion of cases with contraindication to prasugrel, propensity matching resulted in a sample of 2,104 patients with well-adjusted characteristics. Clopidogrel was the dominant P2Y12 inhibitor in both groups (unguided: 96% vs PFT guided: 85%, p <0.001). In the PFT-guided group, 19% of patients had HPRoC and 77% of them were switched to prasugrel. According to the adjusted analysis, all-cause mortality at 1 year was significantly lower in the PFT-guided compared with the unguided group (hazard ratio 0.57 [95% confidence interval 0.43 to 0.77], p <0.001). Although prasugrel treatment was not associated with lower all-cause mortality in the overall cohort, patients with HPRoC who switched to prasugrel had significantly lower mortality when compared with those continuing clopidogrel (hazard ratio 0.33 [95% confidence interval 0.12 to 0.92], p <0.05). In conclusion, in patients with AMI, PFT-guided treatment with a high rate of switchover to prasugrel was associated with a lower risk of mortality. Prasugrel was a predictor of lower mortality in patients with HPRoC but not in the overall cohort of AMI.

Original languageEnglish
Pages (from-to)1129-1137
Number of pages9
JournalAmerican Journal of Cardiology
Volume121
Issue number10
DOIs
Publication statusPublished - May 15 2018

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clopidogrel
Registries
Blood Platelets
Myocardial Infarction
Mortality
Therapeutics
Confidence Intervals
Propensity Score
Hungary
Cardiology
Prasugrel Hydrochloride

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of Platelet Function Guided Versus Unguided Treatment With P2Y12 Inhibitors in Patients With Acute Myocardial Infarction (from the Hungarian Myocardial Infarction Registry). / Komócsi, A.; Aradi, Dániel; Szűk, Tibor; Nagy, Gergely György; Noori, Ebrahim; Ruzsa, Zoltán; Kiss, R.; Andrássy, Péter; Nagy, Lajos; Nagy, Ferenc Tamás; Lupkovics, Géza; Kőszegi, Zsolt; Dézsi, Csaba András; Papp, E.; Molnár, Zsolt; Kupó, Péter; Ofner, Péter; Merkely, B.; Jánosi, A.

In: American Journal of Cardiology, Vol. 121, No. 10, 15.05.2018, p. 1129-1137.

Research output: Contribution to journalArticle

Komócsi, A. ; Aradi, Dániel ; Szűk, Tibor ; Nagy, Gergely György ; Noori, Ebrahim ; Ruzsa, Zoltán ; Kiss, R. ; Andrássy, Péter ; Nagy, Lajos ; Nagy, Ferenc Tamás ; Lupkovics, Géza ; Kőszegi, Zsolt ; Dézsi, Csaba András ; Papp, E. ; Molnár, Zsolt ; Kupó, Péter ; Ofner, Péter ; Merkely, B. ; Jánosi, A. / Comparison of Platelet Function Guided Versus Unguided Treatment With P2Y12 Inhibitors in Patients With Acute Myocardial Infarction (from the Hungarian Myocardial Infarction Registry). In: American Journal of Cardiology. 2018 ; Vol. 121, No. 10. pp. 1129-1137.
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abstract = "Evidence is conflicting regarding the clinical benefits of selecting P2Y12 inhibitors based on platelet function testing (PFT). Between March 1, 2013 and March 1, 2014, we collected clinical characteristics and platelet function data in a nationwide acute myocardial infarction (AMI) registry from 15 interventional cardiology centers in Hungary. The risk of all-cause mortality at 1 year were compared after propensity score (PS) matching between patients receiving PFT-guided and unguided P2Y12-inhibitor therapies. High platelet reactivity on clopidogrel (HPRoC) was uniformly defined with the Multiplate assay. A total of 5,583 patients with AMI and coronary intervention were registered. After exclusion of cases with contraindication to prasugrel, propensity matching resulted in a sample of 2,104 patients with well-adjusted characteristics. Clopidogrel was the dominant P2Y12 inhibitor in both groups (unguided: 96{\%} vs PFT guided: 85{\%}, p <0.001). In the PFT-guided group, 19{\%} of patients had HPRoC and 77{\%} of them were switched to prasugrel. According to the adjusted analysis, all-cause mortality at 1 year was significantly lower in the PFT-guided compared with the unguided group (hazard ratio 0.57 [95{\%} confidence interval 0.43 to 0.77], p <0.001). Although prasugrel treatment was not associated with lower all-cause mortality in the overall cohort, patients with HPRoC who switched to prasugrel had significantly lower mortality when compared with those continuing clopidogrel (hazard ratio 0.33 [95{\%} confidence interval 0.12 to 0.92], p <0.05). In conclusion, in patients with AMI, PFT-guided treatment with a high rate of switchover to prasugrel was associated with a lower risk of mortality. Prasugrel was a predictor of lower mortality in patients with HPRoC but not in the overall cohort of AMI.",
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AU - Aradi, Dániel

AU - Szűk, Tibor

AU - Nagy, Gergely György

AU - Noori, Ebrahim

AU - Ruzsa, Zoltán

AU - Kiss, R.

AU - Andrássy, Péter

AU - Nagy, Lajos

AU - Nagy, Ferenc Tamás

AU - Lupkovics, Géza

AU - Kőszegi, Zsolt

AU - Dézsi, Csaba András

AU - Papp, E.

AU - Molnár, Zsolt

AU - Kupó, Péter

AU - Ofner, Péter

AU - Merkely, B.

AU - Jánosi, A.

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