Correlation of Platelet Reactivity and C-Reactive Protein Levels to Occurrence of Peri-Procedural Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention (From the ARMYDA-CRP Study)

Study Questions:

What is the correlation of elevated C-reactive protein (CRP) level and/or high on-treatment platelet reactivity (HPR) with the incidence of periprocedural myocardial infarction (PMI) in patients who undergo percutaneous coronary intervention (PCI)?

Methods:

Five hundred consecutive patients treated with clopidogrel who underwent PCI had preprocedural measurement of CRP levels and platelet reactivity using the point-of-care VerifyNow P2Y12 assay. Elevated inflammatory status was defined as CRP >3 mg/L and HPR as P2Y12 reactivity units ≥240. The primary endpoint was the incidence of PMI in relation to platelet reactivity and/or inflammatory status. Odds ratios (ORs) and 95% confidence intervals (CIs) investigating the independent predictive role of HPR and/or high CRP level on the occurrence of the primary endpoint were assessed using logistic regression.

Results:

Rates of PMI were increased in patients with CRP levels >3 mg/L (10.9% vs. 4.6% in those with normal levels, OR 2.4, 95% CI 1.2-4.5, p = 0.015) and in patients with HPR (11% vs. 5.5% in those without HPR, OR 2.2, 95% CI 1.2-4.4, p = 0.018). The occurrence of PMI was highest in the subgroup with HPR and high inflammatory status (16.6% vs. 3.6% in patients with CRP ≤3 mg/L and P2Y12 reactivity units <240, OR 4.3, 95% CI 1.5-12.6, p = 0.008). HPR in association with elevated CRP levels resulted in a significant increase in the discriminatory power of a model including clinical and procedural variables in predicting PMI (area under the curve 0.811, p = 0.041).

Conclusions:

The authors concluded that in patients who undergo PCI, baseline stratification according to platelet reactivity and inflammatory status may identify those at higher risk for PMI.

Perspective:

This prospective study suggests that enhanced baseline inflammatory status is associated with a significant increase in the risk for PMI in patients who undergo PCI, and this is highest when elevated CRP level is combined with HPR while receiving clopidogrel therapy. These findings support the optimization of drug therapy to reduce PMI in patients who undergo PCI, considering that antithrombotic treatment may also limit inflammation and that drugs with anti-inflammatory properties, including statins, may help decrease thrombosis.

Clinical Topics: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Nonstatins, Novel Agents, Statins, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Odds Ratio, Inflammation, Myocardial Infarction, Platelet Aggregation Inhibitors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Peptides, Cyclic, Ticlopidine, Angioplasty, Balloon, Coronary, Percutaneous Coronary Intervention, Oligopeptides, C-Reactive Protein, Biological Markers, Coronary Angiography, Thrombosis, Cardiovascular Diseases, Confidence Intervals, Platelet Activation, Logistic Models, Platelet Glycoprotein GPIIb-IIIa Complex


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