Abstract
Background
Aspirin resistance has been associated with an adverse long‐term outcome in patients with atherosclerotic coronary artery disease, but more studies are needed.
Hypothesis
The aim of this study was to investigate the impact of aspirin resistance, assessed by the Platelet Function Analyzer‐100 (PFA‐100) (Dade Behring Inc., Deerfield, Ill., USA) on the long‐term prognosis in patients with non‐ST segment elevation acute coronary syndromes (NSTE‐ACS).
Methods
A total of 496 consecutive patients were studied. The 1‐y incidence of cardiovascular death was the prespecified study endpoint. The patients were divided, according to the values of PFA‐100 collagen epinephrine closure time (CEPI‐CT) upon presentation, into aspirin sensitives (those with a PFA‐100 CEPI‐CT > 193 sec) and aspirin resistants (those with a PFA‐100 CEPI‐CT ≤ 193 sec).
Results
Aspirin resistants were younger (p‐value = 0.04), and less frequently hypertensives (p‐value = 0.05) or diabetics (p‐value = 0.04) than aspirin sensitives. By 1 y, the incidence of cardiovascular deaths in the entire cohort was 12.9% (64/496), and aspirin resistants were at significantly higher risk of cardiovascular death (23.1% versus 9.6%; hazard ratio [HR] = 2.6; 95% confidence interval [CI] = 1.6–4.3; p‐value < 0.001), than aspirin sensitives. By multivariate Cox regression analysis, aspirin resistance (a PFA‐100 CEPI‐CT ≤ 193 sec) was among the most potent predictors of the 1‐y incidence of cardiovascular death (HR = 2.8; 95% CI = 1.7–4.6; p‐value < 0.001).
Conclusion
According to the present data, aspirin resistance, assessed by the PFA‐100, is an independent predictor of long‐term cardiovascular mortality in patients with NSTE‐ACS. Copyright © 2009 Wiley Periodicals, Inc.
Keywords: aspirin resistance, Platelet Function Analyzer‐100, acute coronary syndromes, prognosis
Full Text
The Full Text of this article is available as a PDF (137.4 KB).
References
- 1. Grotemeyer KH, Scharafinski HW, Husstedt IW: Two‐year follow‐up of aspirin responder and aspirin non responder. A pilot‐study including 180 post‐stroke patients. Thromb Res 1993; 71: 397–403. [DOI] [PubMed] [Google Scholar]
- 2. Eikelboom JW, Hirsh J, Weitz JI, Johnston M, Yi Q, et al.: Aspirin‐resistant thromboxane biosynthesis and the risk of myocardial infarction, stroke, or cardiovascular death in patients at high risk for cardiovascular events. Circulation 2002; 105: 1650–1655. [DOI] [PubMed] [Google Scholar]
- 3. Gum PA, Kottke‐Marchant K, Welsh PA, White J, Topol EJ: A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol 2003; 41: 961–965. [DOI] [PubMed] [Google Scholar]
- 4. Lev EI, Patel RT, Maresh KJ, Guthikonda S, Granada J, et al.: Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of dual drug resistance. J Am Coll Cardiol 2006; 47: 27–33. [DOI] [PubMed] [Google Scholar]
- 5. Chen WH, Lee PY, Ng W, Tse HF, Lau CP: Aspirin resistance is associated with a high incidence of myonecrosis after non‐urgent percutaneous coronary intervention despite clopidogrel pretreatment. J Am Coll Cardiol 2004; 43: 1122–1126. [DOI] [PubMed] [Google Scholar]
- 6. Gianetti J, Parri MS, Sbrana S, Paoli F, Maffei S, et al.: Platelet activation predicts recurrent ischemic events after percutaneous coronary angioplasty: a 6 mo prospective study. Thromb Res 2006; 118: 487–493. [DOI] [PubMed] [Google Scholar]
- 7. Fuchs I, Frossard M, Spiel A, Riedmuller E, Laggner AN, et al.: Platelet function in patients with acute coronary syndrome (ACS) predicts recurrent ACS. J Thromb Haemost 2006; 4: 2547–2552. [DOI] [PubMed] [Google Scholar]
- 8. Borna C, Lazarowski E, van Heusden C, Ohlin H, Erlinge D: Resistance to aspirin is increased by ST‐elevation myocardial infarction and correlates with adenosine diphosphate levels. Thromb J 2005; 3: 10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Gum PA, Kottke‐Marchant K, Poggio ED, Gurm H, Welsh PA, et al.: Profile and prevalence of aspirin resistance in patients with cardiovascular disease. Am J Cardiol 2001; 88: 230–235. [DOI] [PubMed] [Google Scholar]
- 10. Haubelt H, Anders C, Vogt A, Hoerdt P, Seyfert UT, et al.: Variables influencing platelet function analyzer‐100 closure times in healthy individuals. Br J Haematol 2005; 130: 759–767. [DOI] [PubMed] [Google Scholar]