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Impact of dual non-responsiveness to aspirin and clopidogrel on clinical outcomes in patients treated with drug-eluting stents in the ARCTIC study.

Session Poster Session 6

Speaker Doctor Thomas Cuisset

Event : ESC Congress 2013

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Antiplatelet Agents
  • Session type : Poster Session

Authors : T Cuisset (Marseille,FR), J Silvain (Paris,FR), G Cayla (Nimes,FR), P Motreff (Clermont-Ferrand,FR), D Carrie (Toulouse,FR), Z Boueri (Bastia,FR), E Van Belle (Lille,FR), E Vicaut (Paris,FR), JP Collet (Paris,FR), G Montalescot (Paris,FR)

T. Cuisset1 , J. Silvain2 , G. Cayla3 , P. Motreff4 , D. Carrie5 , Z. Boueri6 , E. Van Belle7 , E. Vicaut8 , J.P. Collet2 , G. Montalescot2 , 1AP-HM - Hospital La Timone - Marseille - France , 2AP-HP - Hospital Pitie-Salpetriere - Paris - France , 3University Hospital of Nimes, Department of Cardiology - Nimes - France , 4University Hospital of Clermont-Ferrand, Department of Cardiology - Clermont-Ferrand - France , 5University Hospital of Toulouse - Rangueil Hospital, Department of Cardiology - Toulouse - France , 6Dpt of Cardiology - Bastia - France , 7Hospital Regional University of Lille - Cardiological Hospital, Department of Cardiology - Lille - France , 8AP-HP - Hospital Lariboisiere, Clinical Research Unit - Paris - France ,

Antithrombotic agents

European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 883

Background: The ARCTIC trial failed to demonstrate improvements in clinical outcomes with platelet-function monitoring and treatment adjustment for PCI. These findings suggest that aspirin and clopidogrel non-response are non-modifiable risk markers by tailored antiplatelet therapy.

Aim: To analyze the outcome of patients included in the ARCTIC trial according to their initial aspirin and clopidogrel response when measured with the VerifyNow assay.

Methods: In the ARCTIC trial, 1213 had an initial measurement of ARU and PRU after treatment by aspirin and clopidogrel. Among theses patients, 419 (34.5%) had high platelet reactivity (HPR) to clopidogrel and 92 (7.6%) to aspirin. We sought to evaluate the occurrence of the composite primary end point (PEP) of death, MI, stent thrombosis, stroke, or urgent revascularization 1 year after stent implantation in distinctive groups of patients: 1/ dual aspirin and clopidogrel nonresponders (n=51, 4.2%) 2/ clopidogrel and aspirin responders (n=753, 62%), isolated clopidogrel nonresponders (n=368, 30.4%) or aspirin nonresponders (n=41, 3.4%) 5/ patients in the conventional arm without monitoring (n=1227). Bleeding endpoints were also analyzed.

Results: Patients with dual non-responsiveness to aspirin and clopidogrel were significantly older, of female gender and diabetes with higher body weight in comparison with patients without HPR to aspirin or clopidogrel. The PEP occurred in 45.1% of patients with dual non-responsiveness to aspirin and clopidogrel, in 36.6% of the isolated aspirin non-responders, in 33.2% of isolated clopidogrel non-responders, in 34.5% of dual responders and in 31.1% of the patients in the conventional arm without any significant difference between different groups. A trend toward a higher rate of the PEP was observed in patients with dual non-responsiveness to aspirin and clopidogrel as compared with dual responders (45.1% vs. 34.5%, HR 1.32; 95% CI, 0.86 to 2.02; P=0.21). There was no difference in the PEP between patients in the monitored group being dual responders and patients in the conventional group. Interestingly, the rate of major bleeding events was significantly higher in patients with dual resistance compared to responders (7.8% vs. 2.1, HR 3.7 [1.2-11], p=0.02).

Conclusion: The present analysis shows that in the ARCTIC trial patients with dual-resistance to aspirin and clopidogrel before PCI had higher risk baseline characteristics with higher ischemic events. The use of more potent antiplatelet strategy, might have contributed to the higher rate of bleeding complications observed in this subgroup.

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