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Cigarette Smoking Does Not Enhance Clopidogrel Responsiveness After Adjusting VerifyNow P2Y12 Reaction Unit for the Influence of Hemoglobin Level
- Source :
- JACC: Cardiovascular Interventions. 9:1680-1690
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- The authors performed this analysis to examine whether the enhanced clopidogrel responsiveness in current smokers is maintained after adjusting the influence of hemoglobin on VerifyNow P2Y12 reaction unit (PRU).PRU is consistently reported to be lower in current smokers. However, PRU has a significant inverse relationship with hemoglobin level, and smokers have higher hemoglobin levels. Because the association between PRU and hemoglobin is likely to be an in vitro phenomenon, we hypothesized that the observed difference in PRU between nonsmokers and current smokers is the result of confounding effect of hemoglobin rather than true difference in platelet reactivity.Three cohorts were combined for the analysis (SNUBH [Seoul National University Bundang Hospital], n = 459; CILON-T [influence of CILostazol-based triple antiplatelet therapy ON ischemic complication after drug-eluting stenT implantation], n = 715; HOST-ASSURE [Harmonizing Optimal Strategy for Treatment of coronary artery stenosis - sAfetyeffectiveneSS of drug-elUting stentsantiplatelet REgimen], n = 1,357). The final combined cohort consisted of 1,314 patients who underwent percutaneous coronary intervention and had VerifyNow P2Y12 assay results. General linear model (analysis of covariance) was used to control the effect of hemoglobin on PRU.A significant inverse correlation was observed between PRU and hemoglobin (r = -0.389; p 0.001). Current smokers showed a significantly higher hemoglobin level (13.5 ± 1.6 vs. 14.4 ± 1.5; p 0.001) but lower PRU level (230.1 ± 90.7 vs. 212.2 ± 83.6; p 0.001). After adjusting the influence of hemoglobin on PRU, there was no difference in PRU between nonsmokers and current smokers (224.1 [95% confidence interval: 218.7 to 229.5] vs. 225.3 [95% confidence interval: 217.2 to 233.3]; p = 0.813).The observed difference in PRU between nonsmokers and current smokers is largely attributable to the difference in hemoglobin level. Enhanced clopidogrel responsiveness in cigarette smokers is not confirmed in this study and the concept of the smokers' paradox needs further validation.
- Subjects :
- Blood Platelets
Male
medicine.medical_specialty
Ticlopidine
Platelet Function Tests
medicine.medical_treatment
Coronary Disease
030204 cardiovascular system & hematology
Hemoglobins
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
P2Y12
Predictive Value of Tests
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Aged
Randomized Controlled Trials as Topic
Retrospective Studies
business.industry
Smoking
Reproducibility of Results
Percutaneous coronary intervention
Drug-Eluting Stents
Middle Aged
Clopidogrel
Receptors, Purinergic P2Y12
Regimen
Treatment Outcome
Anesthesia
Cohort
Conventional PCI
Cardiology
Female
Hemoglobin
Cardiology and Cardiovascular Medicine
business
Biomarkers
Platelet Aggregation Inhibitors
Mace
medicine.drug
Subjects
Details
- ISSN :
- 19368798
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- JACC: Cardiovascular Interventions
- Accession number :
- edsair.doi.dedup.....74863a99068e5c66ec673223084730d2