Correlation of high post-treatment platelet reactivity assessed by light transmittance aggregometry and the VerifyNow P2Y(12) assay

Abstract

In vitro "high post-treatment platelet reactivity" (HPPR) measured with light transmittance aggregometry (LTA) and the VerifyNow P2Y(12) assay has been associated with an increased risk of ischemic events after percutaneous coronary intervention (PCI). However, there are many criteria for HPPR according to the methods used for assessment, and correlations among suggested criteria have not been evaluated. To this end, we enrolled 1,058 unselected patients undergoing PCI in real clinical practice, simultaneously assessed platelet measures with LTA (both 5 and 20 mu mol/l ADP-induced) and the VerifyNow P2Y(12) assay, and based on previous studies, evaluated the following criteria for HPPR: 5 or 20 mu mol/l ADP-induced maximal platelet reactivity (PRmax) a parts per thousand yen50%; 5 mu mol/l ADP-induced late PR (PRlate) > 14%; 20 mu mol/l ADP-induced PRmax a parts per thousand yen62%; and P2Y(12) reaction unit (PRU) a parts per thousand yen240. Receiver-operating characteristics (ROC) curve analysis demonstrated that PRU (cut-off = 241) distinguished between patients with and without 5 mu mol/l ADP-induced PRmax a parts per thousand yen50% (area under curve [AUC] 0.822, sensitivity 83.0%, specificity 66.0%, P < 0.001), and 20 mu mol/l ADP-induced PRmax a parts per thousand yen62% (AUC 0.840, sensitivity 80.7%, specificity 71.4%, P < 0.001), respectively. PRU a parts per thousand yen240 showed a moderate agreement with 5 mu mol/l ADP-induced PRmax a parts per thousand yen50% (kappa = 0.438, concordant rate 71.6%, P < 0.001) and 20 mu mol/l ADP-induced PRmax a parts per thousand yen62% (kappa = 0.505, concordant rate 75.1%, P < 0.001). Cut-offs matched for 20 mu mol/l ADP-induced PRmax a parts per thousand yen50% (PRU = 195) and 5 mu mol/l ADP-induced PRlate > 14 (PRU = 194) also were similar. The presence of significant correlations between the suggested criteria for HPPR has practical implications on the possible use of the VerifyNow P2Y(12) assay for risk stratification in PCI-treated patients.