European Heart Journal Advance Access originally published online on February 10, 2008
European Heart Journal 2008 29(8):992-1000; doi:10.1093/eurheartj/ehn046
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Prognostic significance of post-clopidogrel platelet reactivity assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation
Division of Cardiovascular Diseases, Scripps Clinic, 10666 North Torrey Pines Road, Maildrop S1056, La Jolla, CA 92037, USA
Received 12 June 2007; revised 11 December 2007; accepted 17 January 2008; online publish-ahead-of-print 10 February 2008.
*Corresponding author. Tel: + 1 858 554 5032, Fax: + 1 858 554-6883, Email: price.matthew{at}scrippshealth.org
See page 957 for the editorial comment on this article (doi:10.1093/eurheartj/ehn091)
Aims: The aim of this study was to determine whether platelet reactivity on clopidogrel therapy, as measured by a point-of-care platelet function assay, is associated with thrombotic events after percutaneous coronary intervention (PCI) with drug-eluting stents (DESs).
Methods and results: Platelet reactivity on clopidogrel (post-treatment reactivity) was measured with the VerifyNow P2Y12 assay (Accumetrics Inc., San Diego, CA, USA) in 380 patients undergoing PCI with sirolimus-eluting stents. Receiver-operating characteristic curve analysis was used to derive the optimal cut-off value for post-treatment reactivity in predicting 6 month out-of-hospital cardiovascular (CV) death, non-fatal MI, or stent thrombosis. The mean post-treatment reactivity was 184 ± 85 PRU (P2Y12 reaction units). The optimal cut-off for the combined endpoint was a post-treatment reactivity 
235 PRU [area under the curve 0.711 (95% confidence interval 0.529–0.893), P = 0.03], which was similar to the threshold of the upper tertile (231 PRU). Patients with post-treatment reactivity greater than the cut-off value had significantly higher rates of CV death (2.8 vs. 0%, P = 0.04), stent thrombosis (4.6 vs. 0%, P = 0.004), and the combined endpoint (6.5 vs. 1.0%, P = 0.008).
Conclusion: High post-treatment platelet reactivity measured with a point-of-care platelet function assay is associated with post-discharge events after PCI with DES, including stent thrombosis. Investigation of alternative clopidogrel dosing regimens to reduce ischaemic events in high-risk patients identified by this assay is warranted.
Key Words: Platelets • Thienopyridine • Stent • Clopidogrel • Thrombosis
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