• Grégoire Rangé, Komlavi Yayehd, Loic Belle, Christophe Thuaire, Pascal Richard, Pierre Cazaux, Franck Barbou, René Köning, Stephan Chassaing, Emmanuel Teiger, Romain Berthier, Marie-Pascale Decomis, Jean-Philippe Claudel, Nicolas Delarche, Philippe Brunel, Fabien De Poli, Patrick Dupouy, Farzin Beygui, Franck Albert, Jean-Philippe Collet, Gilles Montalescot, and VERIFRENCHY investigators.
• Department of Cardiology, les hôpitaux de Chartres, Eure-et-Loir, 4, rue Claude-Bernard, 28630 Le Coudray, France. Electronic address: grange@ch-chartres.fr.
• Arch Cardiovasc Dis. 2014 Apr 1;107(4):225-35.

BackgroundDual antiplatelet therapy, comprising aspirin and clopidogrel, is recommended in patients undergoing coronary stenting to avoid the occurrence of stent thrombosis and others ischaemic events. Interindividual response to clopidogrel varies, however, with poor response associated with an increased risk of ischaemic events. New assays are available for testing aspirin and clopidogrel response routinely at the bedside.AimTo evaluate the prognostic value of testing antiplatelet response in an intermediate-risk population undergoing stent implantation.MethodsWe prospectively assessed clopidogrel and aspirin response using the VerifyNow assay at the time of coronary stenting in 1001 patients who presented with stable coronary disease or non-ST-segment elevation acute coronary syndrome. The main ischaemic endpoint was the composite of definite and probable stent thrombosis, cardiovascular death or spontaneous myocardial infarction at one year. The safety endpoint was major bleeding.ResultsOverall, 36.0% of patients had high on-clopidogrel platelet reactivity (OCR) and 8.6% had high on-aspirin platelet reactivity (OAR). The main ischaemic composite endpoint occurred in 3.9% of patients with high vs. 2.3% of patients with normal OCR (hazard ratio 1.66, 95% confidence interval 0.78-3.54; P=0.18). Definite or probable stent thrombosis occurred in 1.1% of patients with high vs. 0.3% of patients with normal OCR (P=0.86). There was no significant difference in ischaemic endpoints according to OAR and there was no difference in rates of major bleeding between patients with high versus normal on-treatment platelet reactivity.ConclusionsOn-treatment platelet reactivity was not associated with 1-year ischaemic or bleeding events in an intermediate-risk population undergoing stent implantation.Copyright © 2014 Elsevier Masson SAS. All rights reserved.

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