Thromb Haemost
DOI: 10.1055/a-1326-5110
Original Article

On-ticagrelor platelet reactivity and clinical outcome in patients undergoing percutaneous coronary intervention for acute coronary syndrome

Platelet reactivity and events on ticagrelor
1  Assistance Publique Hopitaux de Marseille, Cardiology, Marseille, France (Ringgold ID: RIN36900)
1  Assistance Publique Hopitaux de Marseille, Cardiology, Marseille, France (Ringgold ID: RIN36900)
2  Assistance Publique - Hopitaux de Paris, Department of haematology, Paris, France (Ringgold ID: RIN26930)
3  Sorbonne Universités, UPMC Université Paris 06, UMR_S 1166, Paris, France, , France
thomas cuisset
4  CHU Marseille, marseille, France
Caroline Gouarne
5  Institut Paoli-Calmettes, UEMCO, Marseille, France (Ringgold ID: RIN56181)
bernard jouve
6  hopital d'aix en provence, aix en provence, France
Gilles Lemesle
7  Centre Hospitalier Universitaire de Lille, Lille, France (Ringgold ID: RIN26902)
franck paganelli
8  chu nord, cardiology, marseille, France
marie christine alessi
9  La Timone, marseille, France
julien mancini
10  aicx marseille univ, marseille, France
laurent bonello
11  CHU Marseille, cardiology, marseille, France
› Author Affiliations

Clinical Trials Registration: NCT02428725

Background: A strong association between on-thienopyridines platelet reactivity (PR) and the risk of both thrombotic and bleeding events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) has been demonstrated. However, no study has analyzed the relationship between on-ticagrelor PR and clinical outcome in this clinical setting. Objectives: We aimed to investigate the relationship between on-ticagrelor PR, assessed by the vasodilator-stimulated phosphoprotein (VASP) index, and clinical outcome in patients with ACS undergoing PCI. Methods: We performed a prospective, multicenter, observational study of patients undergoing PCI for ACS. PR was measured using the VASP index following ticagrelor loading dose. The primary study endpoint was the rate of Bleeding Academic Research Consortium (BARC) type ≥2 at 1 year. The key secondary endpoint was the rate of major cardiovascular events (MACE) defined as the composite of cardiovascular death, myocardial infarction and urgent revascularization. Results: We included 570 ACS patients, among whom 33.9% had ST-elevation myocardial infarction. BARC type ≥ 2 bleeding occurred in 10.9% and MACE in 13.8%. PR was not associated with BARC ≥ 2 or with MACE (p=0.12 and p=0.56, respectively). No relationship between PR and outcomes was observed, neither when PR was analyzed quantitatively nor qualitatively (low on-treatment PR (LTPR) vs no LTPR). Conclusion: On-ticagrelor PR measured by the VASP was not associated with bleeding or thrombotic events in ACS patients undergoing PCI. PR measured by the VASP should not be used as a surrogate endpoint in studies on ticagrelor.

Publication History

Received: 23 September 2020

Accepted after revision: 25 November 2020

Publication Date:
01 December 2020 (online)

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