PMID- 22682553
OWN - NLM
STAT- MEDLINE
DCOM- 20121009
LR  - 20181201
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 60
IP  - 5
DP  - 2012 Jul 31
TI  - Prognostic value of a high on-clopidogrel treatment platelet reactivity in 
      bivalirudin versus abciximab treated non-ST-segment elevation myocardial 
      infarction patients. ISAR-REACT 4 (Intracoronary Stenting and Antithrombotic 
      Regimen: Rapid Early Action for Coronary Treatment-4) platelet substudy.
PG  - 369-77
LID - 10.1016/j.jacc.2012.02.044 [doi]
AB  - OBJECTIVES: The ISAR-REACT 4 (Intracoronary Stenting and Antithrombotic Regimen: 
      Rapid Early Action for Coronary Treatment-4) platelet substudy aimed to determine 
      the relevance of high on-clopidogrel treatment platelet reactivity (HPR) in 
      non-ST-segment elevation myocardial infarction patients that received abciximab 
      with unfractionated heparin (UFH) or bivalirudin during percutaneous coronary 
      intervention (PCI). BACKGROUND: In patients undergoing PCI, HPR has been linked 
      to a higher risk for ischemic events. The influence of HPR on clinical outcomes 
      may differ with regard to the adjunctive antithrombotic treatment administered. 
      In ISAR-REACT 4, bivalirudin treatment showed similar efficacy profiles as 
      compared to abciximab with UFH. The impact of HPR on clinical outcomes in 
      abciximab with UFH versus bivalirudin treated non-ST-segment elevation myocardial 
      infarction patients has never been investigated specifically. METHODS: A total of 
      564 patients (274 in abciximab/UFH group vs. 290 in bivalirudin group) were 
      enrolled in this study. Presence or absence of HPR following clopidogrel loading 
      was determined by platelet function testing on a Multiplate analyzer (Verum 
      Diagnostica, Munich, Germany). Per study group and stratified in HPR and no-HPR 
      patients, the 30-day incidence of a combined efficacy endpoint (death, myocardial 
      infarction, urgent target vessel revascularization) was determined. RESULTS: For 
      abciximab with UFH, the incidence of the efficacy endpoint was similar in HPR 
      versus no-HPR patients (9.4% vs. 6.7%; odds ratio: 1.4; 95% confidence interval: 
      0.6 to 3.5; p = 0.43). For bivalirudin, the incidence of the efficacy endpoint 
      was significantly higher in HPR versus no-HPR patients (22.0% vs. 5.0%; odds 
      ratio: 5.4; 95% confidence interval: 2.4 to 12.1; p < 0.0001). CONCLUSIONS: For 
      patients with a risk profile similar to the subjects enrolled in this platelet 
      substudy, the impact of HPR on clinical outcomes may depend on the type of 
      adjunctive antithrombotic therapy used during PCI. Further investigations are 
      warranted to clarify whether assessment of platelet function may help tailoring 
      antithrombotic therapy during PCI.
CI  - Copyright (c) 2012 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Sibbing, Dirk
AU  - Sibbing D
AD  - Deutsches Herzzentrum Munchen and 1. Medizinische Klinik, Klinikum rechts der 
      Isar, Technische Universitat Munchen, Lazarettstrasse36, Munich, Germany. 
      dirk@sibbing.net
FAU - Bernlochner, Isabell
AU  - Bernlochner I
FAU - Schulz, Stefanie
AU  - Schulz S
FAU - Massberg, Steffen
AU  - Massberg S
FAU - Schomig, Albert
AU  - Schomig A
FAU - Mehilli, Julinda
AU  - Mehilli J
FAU - Kastrati, Adnan
AU  - Kastrati A
LA  - eng
SI  - ClinicalTrials.gov/NCT00373451
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20120606
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Hirudins)
RN  - 0 (Immunoglobulin Fab Fragments)
RN  - 0 (Peptide Fragments)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - TN9BEX005G (bivalirudin)
RN  - X85G7936GV (Abciximab)
SB  - IM
CIN - J Am Coll Cardiol. 2012 Jul 31;60(5):378-80. PMID: 22682552
MH  - Abciximab
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Antibodies, Monoclonal/adverse effects/*therapeutic use
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Antithrombins/adverse effects/*therapeutic use
MH  - Clopidogrel
MH  - Cohort Studies
MH  - Combined Modality Therapy
MH  - Dose-Response Relationship, Drug
MH  - Drug Administration Schedule
MH  - Drug Therapy, Combination
MH  - Electrocardiography/drug effects
MH  - Female
MH  - Heparin/adverse effects/*therapeutic use
MH  - Hirudins/adverse effects
MH  - Humans
MH  - Immunoglobulin Fab Fragments/adverse effects/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood/mortality/*therapy
MH  - Peptide Fragments/adverse effects/*therapeutic use
MH  - Platelet Aggregation/*drug effects
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Platelet Function Tests
MH  - Prognosis
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Signal Processing, Computer-Assisted
MH  - *Stents
MH  - Survival Analysis
MH  - Ticlopidine/adverse effects/*analogs & derivatives/therapeutic use
EDAT- 2012/06/12 06:00
MHDA- 2012/10/10 06:00
CRDT- 2012/06/12 06:00
PHST- 2011/12/16 00:00 [received]
PHST- 2012/02/08 00:00 [revised]
PHST- 2012/02/23 00:00 [accepted]
PHST- 2012/06/12 06:00 [entrez]
PHST- 2012/06/12 06:00 [pubmed]
PHST- 2012/10/10 06:00 [medline]
AID - S0735-1097(12)01236-3 [pii]
AID - 10.1016/j.jacc.2012.02.044 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2012 Jul 31;60(5):369-77. doi: 10.1016/j.jacc.2012.02.044. 
      Epub 2012 Jun 6.