Original Investigation
Aspirin Treatment and Outcomes After Percutaneous Coronary Intervention: Results of the ISAR-ASPI Registry

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Abstract

Background

Aspirin administration, as part of a dual antiplatelet treatment regimen, is essential for patients undergoing percutaneous coronary intervention (PCI). Although the correlation between high on-clopidogrel treatment platelet reactivity (HCPR) and clinical outcome is well established, data for high on-aspirin treatment platelet reactivity (HAPR) are conflicting.

Objectives

The aim of the ISAR-ASPI (Intracoronary Stenting and Antithrombotic Regimen—ASpirin and Platelet Inhibition) registry was to assess the value of HAPR as a possible prognostic biomarker in PCI-treated patients with regard to clinical outcome.

Methods

From February 2007 to May 2013, we identified 7,090 consecutive PCI-treated patients with measured on-aspirin treatment platelet aggregation values directly before PCI. Platelet function was assessed with a Multiplate analyzer. The primary endpoint was death or stent thrombosis (ST) at 1 year.

Results

The upper quintile of patients (n = 1,414), according to Multiplate measurements, was defined as the HAPR cohort. Compared with non-HAPR patients (n = 5,676), HAPR patients showed a significantly higher risk of death or ST at 1 year (6.2% vs. 3.7%, respectively; odds ratio [OR]: 1.78; 95% confidence interval [CI]: 1.39 to 2.27; p < 0.0001). HAPR was found to be an independent predictor of the primary outcome (adjusted hazard ratio [HRadj]: 1.46; 95% CI: 1.12 to 1.89; p = 0.005).

Conclusions

HAPR, measured at the time point of the PCI, is associated with a higher risk for death or ST during the first year after PCI. Present data are in support of the addition of HAPR to a panel of prognostic biomarkers in PCI-treated patients.

Key Words

aspirin
biomarker
high platelet reactivity
stent thrombosis

Abbreviations and Acronyms

AA
arachidonic acid
ADP
adenosine diphosphate
AU
aggregation units
HAPR
high on-aspirin treatment platelet reactivity
HCPR
high on-clopidogrel treatment platelet reactivity
IDI
integrated discrimination improvement
MACE
major adverse cardiac event(s)
NRI
net reclassification improvement
NSTEMI
non–ST-segment elevation myocardial infarction
ST
stent thrombosis
STEMI
ST-segment elevation myocardial infarction
TIMI
Thrombolysis In Myocardial Infarction

Cited by (0)

Dr. Orban has received honoraria from Roche Diagnostics. Prof. Schunkert has received speaker fees from Sanofi-Aventis and Daiichi-Sankyo; and grants from Bristol-Myers Squibb. Prof. Kastrati has received lecture fees from Daiichi-Sankyo and AstraZeneca; and fees for advisory board activities from AstraZeneca. Dr. Sibbing has received speaker fees from Daiichi Sankyo and Roche; and fees for advisory board activities from Verum Diagnostica and Eli Lilly. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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