2021循环杂志残余血小板活性预测心血管风险CardiovascularDeathandNonfatalMyocardialInfarctioninAcuteCoronarySyndromePatientsReceivingCoronaryStentingArePredictedbyResidualPlateletReactivitytoADPDetectedbyaPoint-of-CareAssay:A12-MonthFollow-UpRossellaMarcucci,AnnaMariaGori,RitaPaniccia,BettiGiusti,SerafinaValente,CristinaGiglioli,PiergiovanniBuonamici,DavidAntoniucci,RosannaAbbateandGianFrancoGensiniCirculation2021;119;237-242;originallypublishedonlineDec31,2021;DOI:10.1161/CIRCULATIONAHA.108.812636CirculationispublishedbytheAmericanHeartAssociation.7272GreenvilleAvenue,Dallas,TX72514Copyright2021AmericanHeartAssociation.Allrightsreserved.PrintISSN:0009-7322.OnlineISSN:1524-4539Theonlineversionofthisarticle,alongwithupdatedinformationandservices,islocatedontheWorldWideWebat:/cgi/content/full/119/2/237Subscriptions:InformationaboutsubscribingtoCirculationisonlineat/subscriptions/Permissions:PermissionsRightsDesk,LippincottWilliamsWilkins,adivisionofWoltersKluwerHealth,351WestCamdenStreet,Baltimore,MD21202-2436.Phone:410-528-4050.Fax:410-528-8550.E-mail:journalpermissions@Reprints:Informationaboutreprintscanbefoundonlineat/reprintsCoronaryHeartDiseaseCardiovascularDeathandNonfatalMyocardialInfarctioninAcuteCoronarySyndromePatientsReceivingCoronaryStentingArePredictedbyResidualPlateletReactivitytoADPDetectedbyaPoint-of-CareAssayA12-MonthFollow-UpRossellaMarcucci,MD;AnnaMariaGori,BS;RitaPaniccia,BS;BettiGiusti,BS;SerafinaValente,MD;CristinaGiglioli,MD;PiergiovanniBuonamici,MD;DavidAntoniucci,MD;RosannaAbbate,MD;GianFrancoGensini,MDBackground—Theclinicalimpactofplateletaggregationassessedbypoint-of-careassaysisunknown.Wesoughttoevaluatewhetherhighresidualplateletreactivity(RPR)toADPduringclopidogreltherapy,measuredbyapoint-of-careassay,predictsadverseclinicaleventsinacutecoronarysyndromepatientsundergoingpercutaneouscoronaryintervention.MethodsandResults—WeusedtheVerifyNowP2Y12assay(AccumetricsInc,SanDiego,Calif)todetermineRPRtoADPin683patientswithacutecoronarysyndromeundergoingdual-antiplatelettherapywhounderwentpercutaneouscoronaryinterventionwithbare-metalordrug-elutingstentimplantation.Allpatientsreceivedasingle600-mgclopidogrelloadingdosefollowedby75mgofclopidogreldailyand100to325mgofaspirindaily.Theendpointsofthestudyatfollow-upof12monthswerecardiovasculardeath,nonfatalmyocardialinfarction(MI),andtarget-vesselrevascularization.Ata12-monthfollow-up,wefound51ischemicevents(24cardiovasculardeaths[3.5%],27nonfatalMIs[3.9%])and40target-vesselrevascularizations(5.8%).Byreceiveroperatingcharacteristiccurve(ROC)analysis,theoptimalcutoffvalueinpredicting12-monthcardiovasculardeathandnonfatalMIwasP2Y12reactionunitvalues240.RPR,definedinthepresenceofP2Y12reactionunitvaluesabovethiscutoff,wasfoundtobeasignificantandindependentpredictorofcardiovasculardeathandnonfatalMIinamodelthatadjustedforcardiovascularriskfactors,renalfailure,reducedleftventricularejectionfraction,multivesseldisease,totalstentlength,bifurcationlesions,numberoflesionstreated,typeofstent,anduseofglycoproteinIIb/IIIainhibitors(cardiovasculardeath:hazardratio2.55,95%CI1.08to6.07,P0.034;nonfatalMI:hazardratio3.36,95%CI1.49to7.58,P0.004).NosignificantassociationwasfoundbetweenhighRPRandtheriskoftarget-vesselrevascularization.Conclusions—RPRtoADPwithclopidogreltherapy,measuredbythepoint-of-careassayVerifyNowP2Y12,isabl...