Background
Clopidogrel low response correlates with poor prognosis after percutaneous coronary intervention (PCI). It is today clearly demonstrated that there is a large inter-individual variability in clopidogrel response. Some authors also suggest intra-individual variability over time. We assessed the impact of initial clinical presentation on clopidogrel low response.
Methods
In this prospective study, clopidogrel response was assessed in 100 patients following PCI: 50 presented with acute coronary syndrome (ACS group) and 50 patients with stable coronary disease (scheduled PCI) were matched 1 to 1 on age, sex, BMI, and diabetes (stable group). All patients were tested between 18 h and 24 h after a 600 mg clopidogrel loading dose using the test of VerifyNow-P2Y12 (results expressed as PRU). Patients under chronic clopidogrel therapy or treated with Gp IIb-IIIa inhibitors were excluded.
Methods
In this prospective study, clopidogrel response was assessed in 100 patients following PCI: 50 presented with acute coronary syndrome (ACS group) and 50 patients with stable coronary disease (scheduled PCI) were matched 1 to 1 on age, sex, BMI, and diabetes (stable group). All patients were tested between 18 h and 24 h after a 600 mg clopidogrel loading dose using the test of VerifyNow-P2Y12 (results expressed as PRU). Patients under chronic clopidogrel therapy or treated with Gp IIb-IIIa inhibitors were excluded.
Results
The mean age was 61 ± 12 in each group. Altogether, 28% patients were diabetics in each group and the mean BMI was 27.6 ± 5.6 and 27.9 ± 5.9 in the ACS group and stable group, respectively ( P = ns). The mean PRU values were 159 ± 94 and 197 ± 80 in the ACS group and stable group, respectively ( P = .033). By multivariate analysis, “ACS group” was significantly associated with higher PRU value ( P = .018) (see Table 1 ).
| Categorical variables mean PRU | Continuous variables correlation K | Univariate analysis P value | Multivariate analysis P value | |
|---|---|---|---|---|
| Clinical presentation | ||||
| Stable group | 159 | .033 | .018 | |
| ACS group | 197 | |||
| Age | 0.283 | .004 | .076 | |
| Sex | ||||
| Male | 202 | .068 | .207 | |
| Female | 167 | |||
| BMI | 0.215 | .033 | .026 | |
| Tabac | ||||
| No | 155 | .005 | .536 | |
| Yes | 205 | |||
| Diabetes | ||||
| No | 205 | .06 | .684 | |
| Yes | 167 | |||
| Renal failure | ||||
| No | 174 | .182 | .775 | |
| Yes | 216 | |||
| Proton pump inhibitor | ||||
| No | 202 | .075 | .418 | |
| Yes | 167 |
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