Identification of platelet hyper-reactivity measured with a portable device immediately after percutaneous coronary intervention predicts in stent thrombosis

Introduction: Platelet hyper-reactivity, despite a standard anti-thrombotic therapy, is a recognized risk factor for recurrent myocardial ischemia and in-stent thrombosis following PCI. We have investigated whether this detrimental condition, measured by collagen-epinephrine closure times (CEPI-CT) with the Platelet Function Analyzer (PFA-100) device could predict IST defined as the composite of cardiovascular death or myocardial infarction. Materials and methods: CEPI-CT was measured in 256 consecutive patients with stable angina (n=103) or ACS (n=153) 30±8 h after PCI (T0) and 1 month later (T1). All patients were followed up for a mean period of 9 months. Platelet hyperactivity was defined as a CEPI-CTb190 s. Results: Baseline CEPI-CTb190 s was associated with a higher rate of death or MI (LogRank ?2 =4.23, p=0.039) as compared with CEPI-CTN190 s (4.6% vs. 0.7%). Multivariable analysis after adjustment for other risk factors confirmed that baseline CEPI-CTb190 s was an independent correlate for death or MI (Hazard ratio 6.981, p=0.008). At T1 there was a significant prolongation of CEPI-CT (p=0.03) from 208± 64 s to 240±59 s but T1 did not predict any event.