Relationship Between Platelet Reactivity and Periprocedural Myonecrosis in Patients Undergoing Percutaneous Coronary Intervention

Background. The impact of platelet reactivity on periprocedural myonecrosis [PMN] in East Asian patients with stable ischemic heart disease or non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention [PCI] is unclear. Methods. We enrolled 256 patients with normal high-sensitivity troponin 1 levels who underwent PCI for stable ischemic heart disease or non-ST elevation acute coronary syndrome. Residual platelet reactivity was assessed by VerifyNow point-of-care P2Y(12) assay before PCI and at 18-24 hours following PCI, High platelet reactivity [HPR] was defined using three cut-off scores for platelet reactivity units [PRUs]. PMN was defined as a high-sensitivity troponin I elevation of >5x the 99th percentile upper reference limit [URL] in patients with normal baseline values [<99th percentile URL], Results. The rate of PMN was 55.9% [n = 143] and was significantly higher for pre-PCI and post-PCI PRU values in the fourth quartile compared with those in the first quartile [15% vs 37% [P<,001] and 20% vs 36% [P<,001], respectively]. The rate of PMN was higher in patients with HPR, regardless of the criteria used [PRU >208, PRU >235, and PRU >272] and time point. Multivariable analysis revealed that pre-PCI HPR I PRU >208] was an independent predictor of increased risk of PMN [odds ratio, 3.39; 95% confidence interval, 1.87-6.17; P<,001], Conclusion. Pre-PCI HPR [PRU >208] was associated with an increased risk of PMN in East Asian patients with stable ischemic heart disease or non-ST elevation acute coronary syndrome undergoing PCI. Achievement of optimal platelet reactivity may decrease the risk of PMN.