A Point-of-Care Platelet Function Assay and C-Reactive Protein for Prediction of Major Cardiovascular Events After Drug-Eluting Stent Implantation

Study Questions:

What is the value of measuring platelet reactivity and C-reactive protein (CRP) levels for predicting adverse events following drug-eluting stent (DES) implantation?

Methods:

More than 2,500 patients who received DES and had post-PCI VerifyNow P2Y12 assays performed, and baseline CRP measurements were followed for a median 2.2 years. The primary endpoint was a composite of death, nonfatal myocardial infarction, stent thrombosis, and stroke.

Results:

During follow-up, the occurrence of the primary endpoint did not significantly differ among patients with and without high on-treatment platelet reactivity (2.8% vs. 2.4% at 2 years; p = 0.18). By contrast, patients with elevated CRP levels (≥3.0 mg/L) were at significantly higher risk for the primary endpoint (5.6% vs. 1.7% at 2 years; hazard ratio, 2.81; p < 0.001). The VerifyNow test had no incremental usefulness to classify long-term risk. However, the incorporation of CRP into a model with conventional clinical and procedural risk factors significantly improved the C-statistic for the prediction of the primary endpoint (0.729-0.759; p = 0.03).

Conclusions:

The authors concluded that high on-treatment platelet reactivity measured by VerifyNow P2Y12 assay was not significantly associated with long-term atherothrombotic risks in patients receiving DES. However, elevated CRP levels were significantly associated with worse outcomes, and had incremental predictive values over conventional risk factors.

Perspective:

Identification of risk factors for vascular events following stent placement may allow for tailoring of antiplatelet therapies to match individual risk profiles. However, based on several recent studies, it remains controversial whether the use of genetic or platelet function data will lead to changes in therapy that reduce the frequency of adverse events. In the current study, despite a low adverse event rate, baseline CRP measurements were found to be potentially useful to risk stratify patients following DES. The clinical utility of CRP measurements, alone or in combination with other biomarkers of platelet function, will require further study.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Interventions and Imaging, Angiography, Nuclear Imaging, Chronic Angina

Keywords: Myocardial Infarction, Stroke, Follow-Up Studies, Platelet Function Tests, Coronary Restenosis, Drug-Eluting Stents, Risk Factors, Angioplasty, Balloon, Coronary, Stents, Incidence, C-Reactive Protein, Biological Markers, Coronary Angiography, Thrombosis, Parkinson Disease, Platelet Activation


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