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Semin Thromb Hemost
DOI: 10.1055/a-2570-4538
Original Article

Comparison of Platelet Function Tests for Long-Term Cardiovascular Events after Percutaneous Coronary Interventions

Mingyao Zhou   *
1   Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
,
Pan Hou   *
1   Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
2   Department of Cardiology, General Hospital of the PLA Central Theater Command, Wuhan, People's Republic of China
,
Ying Liang   *
1   Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
,
Wenqi Tao   *
3   Department of Cardiology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, People's Republic of China
,
Zhifu Guo
1   Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
,
Bili Zhang
1   Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
,
Yang Lu
4   Department of Cardiology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
,
Guojun Chu
5   Department of Cardiology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
,
Pan Li
1   Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
› Author Affiliations
Funding The current study was funded by grants from the Shanghai Changhai Hospital “YuanHang Project” and Shanghai Changhai Hospital General Program (2023PY43).
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Abstract

Patients with high on-treatment platelet reactivity (HTPR) undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) face increased risks of major adverse cardiovascular events (MACEs). Although platelet function tests like thrombelastography (TEG), vasodilator-stimulated phosphoprotein (VASP), PL-11, and VerifyNow have been described, the correlation between them and their prognostic implications remains uncertain. This prospective study aims to evaluate the consistency and effectiveness of four platelet function detection methods in predicting long-term MACEs in patients with ACS. All 98 ACS patients undergoing PCI with clopidogrel were assessed for HTPR using four platelet function detection methods. The endpoint was the occurrence of MACEs, including cardiac death, nonfatal myocardial infarction (MI), and target vessel revascularization (TVR). Among 98 patients enrolled from April 1, 2014 to June 30, 2014, 27 (27.6%) patients with VerifyNow-detected HTPR (P2Y12 reaction units [PRUs] >240). The incidence of HTPR was 58.2% for TEG, 52% for VASP, and 13.3% for PL-11. VerifyNow and TEG showed the highest consistency in detecting HTPR (kappa = 0.201, p = 0.015). During a median follow-up of 6.1 years, 29 MACEs occurred, including 24 TVRs, 3 cardiovascular deaths, and 2 nonfatal MIs. VerifyNow-detected HTPR independently predicted long-term MACEs (hazard ratio: 5.73, 95% confidence interval: 2.04–16.09, p = 0.001), even after adjusting for traditional risk factors (TRFs). Receiver operating characteristic (ROC) analysis indicated that the model incorporating TRFs and VerifyNow-detected HTPR had superior predictive discrimination for MACEs (area under ROC curve = 0.889). VerifyNow-detected HTPR independently emerges as a robust predictor for long-term MACEs, demonstrating superior predictive discrimination compared with other platelet function tests.

Keywords

platelet function tests - major adverse cardiovascular event - VerifyNow - high on-treatment platelet reactivity

Authors' Contributions

P.L., G.J.C., and Y.L. performed the study design. P.H. analyzed data and drafted the manuscript. M.Y.Z., Y.L., and W.Q.T. contributed to the study conception and data collection, analysis, and interpretation. All authors contributed to the revision of the manuscript, read and approved the final manuscript and have participated sufficiently in the work, and agreed to be accountable for all aspects of the work.


Ethics Approval and Consent to Participate

The trial followed the Declaration of Helsinki and had approval from the Institutional Review Board of Changhai Hospital. Each participant provided written informed consent.


* These authors are co-first authors and have contributed equally to this article.




Publication History

Received: 06 January 2025

Accepted: 31 March 2025

Article published online:
25 April 2025

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