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The article discusses a study of the role of high residual platelet reactivity (HRPR) after clopidogrel loading as a prognostic marker of long-term thrombotic events risk in acute coronary syndromes (ACS) patients undergoing an invasive procedure and receiving long-term anti-thrombotic treatment. The study involved 1,789 patients at the Careggi Hospital Division of Cardiology in Florence, Italy from April 2005 to April 2009. There was a 14% incidence of high residual platelet reactivity after clopidogrel loading. Results show a link between high residual platelet reactivity and cardiac mortality. One of the study limitations was the use of data from a prospective nonrandomized registry.