2010循环杂志残余血小板活性预测心血管风险(6)

MarcuccietalPlateletReactivityandIschemicEvents241

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Figure4.HRsforcardiovascular(CV)deathandnonfatalMIbyquartilesofPRUvalues.Qindicatesquartile.

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parameters,includingthehighleveloftheinflammatorystate17–19andtheincreasedplateletturnover.20–23Conse-quently,apercentageofpatientswithRPRintheacutephaseofdiseasemightsubsequentlyreturntoanadequateplateletinhibitionlevelafterastandarddoseofclopidogrel.There-fore,thepresentresultsstrengthentheevidencethatanimpairedandreducedinhibitionofplateletfunctionbyclopidogrelintheacutephaseofthediseaseisassociatedwithsubsequentworseclinicalfollow-up,whichunderscorestheimportanceofoptimalplateletinhibitionintheacutephaseofthedisease.Thisparadigmmirrorstheclinicalrelevanceoftheoptimizationofanticoagulationtherapyintheacutephaseofdeepvenousthrombosistotheriskofclinicalrecurrence,ie,thebettertheanticoagulationtherapyintheacutephase,thelowertheriskofclinicalrecurrence.However,theavailabilityofasimpletestfortheassessmentofthisbiologicalentity(persistentinvitroplatelethyperre-activitywiththerapy)inthepanelofclinical,laboratory,andproceduralriskfactorsmayallowbetterriskstratificationandidentificationofpatientsinwhoman“aggressive”bloodislikelytoplayakeyroleinmakingthepatienta“vulnerable”patient.

Inconclusion,theresultsofthepresentstudyindicatethatplatelethyperreactivity,measuredbythepoint-of-careassayVerifyNowP2Y12,isabletoidentifyACSpatientsathigherriskof12-monthadverseclinicaleventsandthatthecutoffvalueof240PRUcanbeusedforclinicalandinterventiontrials.

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SourcesofFunding

ThisstudywassupportedinpartbyagranttotheFiorGenFoundationbyEnteCassadiRisparmioFlorence,Italy.

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Disclosures

None.

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