This was a prospective study comparing two groups: personalized and non-personalized treatment with P2Y12 receptor blockers during a 12-month follow-up. We aimed to investigate whether personalized antiplatelet treatment in patients with high on-treatment platelet reactivity (HTPR) improves clinical outcome. Platelet reactivity was assessed by adenosine diphosphate induced aggregation using a multiple electrode aggregometry (MEA) in 798 patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). Patients with HTPR received up to four repeated loading doses of clopidogrel or prasugrel in the personalized treatment group (n=403), whereas no change in the treatment strategy was undertaken in patients with HTPR in the non-personalized treatment group (n=395). There were fewer major adverse cardiac events (MACE) in the personalized treatment group than in the non-personalized treatment group (7.4% compared with 15.3% respectively; P<0.001). The multivariate Cox regression analysis showed that the relative risk to develop MACE was 51% lower in the personalized treatment group as compared with the non-personalized treatment group [hazard ratio (HR)=0.49; 95% confidence interval (CI): 0.31–0.77; P<0.001]. Similarly, there was a clear net benefit of the personalized antiplatelet treatment over the non-personalized treatment (ischemic and bleedings events: 8.2% versus 18.7% respectively; HR=0.46; 95%CI: 0.29–0.70; P<0.001). Further analysis indicated that patients with aggregation values within the therapeutic window (21–49 units) experienced the lowest event rates (stent thrombosis and major bleeding: 2.5%) as compared with poor responders (≥50 units: 5.4%) or ultra-responders (0–20 units: 5.2%). In conclusion, personalized antiplatelet treatment might improve patients’ outcome without increasing bleeding complications compared with the non-personalized treatment during a 12-month follow-up.
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Research Article|
September 19 2014
The net clinical benefit of personalized antiplatelet therapy in patients undergoing percutaneous coronary intervention
Jolanta M. Siller-Matula;
*Department of Cardiology, Medical University of Vienna, Austria
Correspondence: Dr Jolanta Siller-Matula (email [email protected]) or Professor Günter Christ (email [email protected])
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Carina Gruber;
Carina Gruber
†5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria
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Marcel Francesconi;
Marcel Francesconi
†5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria
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Cornelia Dechant;
Cornelia Dechant
†5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria
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Bernd Jilma;
Bernd Jilma
‡Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Georg Delle-Karth;
Georg Delle-Karth
*Department of Cardiology, Medical University of Vienna, Austria
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Katharina Grohs;
Katharina Grohs
§Clinical Institute for Laboratory Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
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Andrea Podczeck-Schweighofer;
Andrea Podczeck-Schweighofer
†5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria
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Günter Christ
†5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria
Correspondence: Dr Jolanta Siller-Matula (email [email protected]) or Professor Günter Christ (email [email protected])
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Publisher: Portland Press Ltd
Received:
May 15 2014
Revision Received:
July 29 2014
Accepted:
August 15 2014
Accepted Manuscript online:
August 15 2014
Online ISSN: 1470-8736
Print ISSN: 0143-5221
© The Authors Journal compilation © 2015 Biochemical Society
2015
Clin Sci (Lond) (2015) 128 (2): 121–130.
Article history
Received:
May 15 2014
Revision Received:
July 29 2014
Accepted:
August 15 2014
Accepted Manuscript online:
August 15 2014
Citation
Jolanta M. Siller-Matula, Carina Gruber, Marcel Francesconi, Cornelia Dechant, Bernd Jilma, Georg Delle-Karth, Katharina Grohs, Andrea Podczeck-Schweighofer, Günter Christ; The net clinical benefit of personalized antiplatelet therapy in patients undergoing percutaneous coronary intervention. Clin Sci (Lond) 1 January 2015; 128 (2): 121–130. doi: https://doi.org/10.1042/CS20140310
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