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Antithrombotics Acute Myocardiac Infarction/Acute Coronary Syndrome IV Wednesday, April 24, 2013 5:00 PM w 6:00 PM (Abstract nos. AS-024, AS-025, AS-134) - AS-024 WITHDRAWN. - AS-025 Comparison of Platelet Inhibition with Prasugrel versus Adjunctive Cilostazol to Dual Anti-platelet Therapy in Patients with ST Segment Elevation Myocardial Infarction. Keun-Ho Park, Myung Ho Jeong, Youngkeun Ahn, Doo Sun Sim, Young Joon Hong, Ju Han Kim, Jeong Gwan Cho, Jong Chun Park. Chonnam National University Hospital, Gwangju, Korea (Republic of). Background: The inhibition of platelet aggregation (IPA) by anti- platelet agent was important to reduce the thrombo-embolic events in patients with ST segments elevation myocardial infarction (STEMI) planned percutaneous coronary intervention (PCI). However, peri- procedural IPA by prasugrel was well unknown. We compared the pre- PCI and in-hospital IPA between prasugrel and adjunctive cilostazol to dual anti-platelet therapy (Triple anti-platelet therapy; TAP) in patients with STEMI. Methods: We prospectively randomized before coronary angiog- raphy 63 consecutive clopidogrel-naive patients with STEMI to either prasugrel [loading dose (LD) 60mg, maintenance dose (MD) 10mg; 32 patients] or TAP (LD aspirin 300mg, clopidogel 600mg, and cilostazol 200mg; 31 patients). Primary end points of the study were the platelet reactivity unit (PRU) or % inhibition by the VerifyNow P2Y12 point- of-care assay at pre-PCI and 5-day after PCI. Results: At pre-PCI, the drug loading to examination time was similar between prasugrel and TAP groups (24.610.34 minutes vs. 27.012.40 minutes, p¼0.406). PRU was lower and % inhibition tended to be greater in prasugrel than in TAP at pre-PCI (267.174.25 vs. 300.446.69, p¼0.041; 3.310.59% vs. 0.0%, p¼0.084). The cardiac death, non-fatal MI, or stent thrombosis did not occur in both groups during hospitalization. However, The cerebrovascular accident occurred in 1 patient in TAP group. The lower PRU and greater % inhibition also occurred with prasugrel than with TAP at 5-days after PCI (107.659.91 vs. 235.487.93; 64.117.80% vs. 18.320.35%, p<0.001 respectively). Conclusion: Our study presents that prasugrel has a greater peri- procedural as well as in-hospital IPA compared with TAP in patients with STEMI. - AS-134 Platelet Function Tests Variability Study. Ho Lam, Kowk Kit Yeung, Yam Hong Wong, Kowk Chun Ko, Yu Ho Chan, Wei Fung Leung, Ka Lung Chui, Chi Wing Wong, Sze Fai Yip, Man Lok Wong, Ping Wah Yam, Cheuk Sum Lam. Tuen Mun Hospital, Tuen Mun, Hong Kong, China. Background: Antiplatelet treatment failure leads to increase clinical events for patients undergoing PCI. Checking antiplatelet treatment efcacy before PCI to tailor the drug dosage becomes more and more popular. However, most of the studies are done with one platelet function test only. Comparison between different tests to check their consistency has not been well studied. Recently, a POPularTrial has studied different point of care antiplatelet function tests. It shows that some platelet function tests cannot demonstrate predictive value. Methods: This is a prospective observational trial to test consistency between different platelet function tests from the most popular point for care VerifyNow, to most well-accepted ow cytometry measurement of vasodilator-stimulated phosphoprotein phosphorylation (VASP) and the new WBA platelet function test (Whole Blood Impedance Aggregom- etry). 31 consecutive patients undergoing elective PCI in Tuen Mun Hospital from 11/2011 to 12/2011 are selected for 3 different platelet function tests with written consent after elective PCI. All patients are treated with aspirin 160mg and clopidogrel 300mg loading plus 75mg maintenance. 20 healthy subjects (11 male and 9 female) were used to set up normal range. Results: By verify now, patients (n¼31) show PRU 81-348. If we take PRU> 230 as cutoff, 54.8 % (n¼17) patients are non responder. By VASP, patients (n¼31) show PRI 25.5 -83.7. If we take PRI>50 as cutoff, 37.7% (n¼21) patients are non responder. By WBA using collagen as platelet agonist, patients (n¼23) shows 6 minutes imped- ance 2-19. If we take >10 as cutoff value, 28.6% (n¼6) patients are non responder. Comparison between VASP and Verify Now (n¼31) nds 61.3% (n¼19) patients showing consistent result between the two tests, namely 38.7% inconsistency. Among 21 patients tested by all the 3 tests, only 28.6% (n¼6) patients show consistent results between the tests. Conclusion: This small study demonstrates the problem of inconsis- tency between different platelet function tests results, which may affect the clinical usage and it urges the need for searching a gold standard in platelet function test in the future, especially after GRAVITAS Trial. It is alarming to nd high prevalence of plavix non responder in our local population undergoing PCI. The American Journal of Cardiology â APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral 11B O R A L A B S T R A C T S APRIL 23e26, 2013

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ABSTRACTS

APRIL 23e26, 2013

Antithrombotics

Acute Myocardiac Infarction/AcuteCoronary Syndrome IV

Wednesday, April 24, 2013

5:00 PM w 6:00 PM

(Abstract nos. AS-024, AS-025,AS-134)

- AS-024

WITHDRAWN.

- AS-025

Comparison of Platelet Inhibition with Prasugrel versus AdjunctiveCilostazol to Dual Anti-platelet Therapy in Patients with STSegment Elevation Myocardial Infarction. Keun-Ho Park,Myung Ho Jeong, Youngkeun Ahn, Doo Sun Sim, Young Joon Hong,Ju Han Kim, Jeong Gwan Cho, Jong Chun Park. Chonnam NationalUniversity Hospital, Gwangju, Korea (Republic of).

Background: The inhibition of platelet aggregation (IPA) by anti-platelet agent was important to reduce the thrombo-embolic events inpatients with ST segments elevation myocardial infarction (STEMI)planned percutaneous coronary intervention (PCI). However, peri-procedural IPA by prasugrel was well unknown. We compared the pre-PCI and in-hospital IPA between prasugrel and adjunctive cilostazol todual anti-platelet therapy (Triple anti-platelet therapy; TAP) in patientswith STEMI.

Methods: We prospectively randomized before coronary angiog-raphy 63 consecutive clopidogrel-naive patients with STEMI to eitherprasugrel [loading dose (LD) 60mg, maintenance dose (MD) 10mg; 32patients] or TAP (LD aspirin 300mg, clopidogel 600mg, and cilostazol200mg; 31 patients). Primary end points of the study were the plateletreactivity unit (PRU) or % inhibition by the VerifyNow P2Y12 point-of-care assay at pre-PCI and 5-day after PCI.

Results: At pre-PCI, the drug loading to examination time wassimilar between prasugrel and TAP groups (24.6�10.34 minutes vs.27.0�12.40 minutes, p¼0.406). PRU was lower and % inhibitiontended to be greater in prasugrel than in TAP at pre-PCI (267.1�74.25vs. 300.4�46.69, p¼0.041; 3.3�10.59% vs. 0.0%, p¼0.084). Thecardiac death, non-fatal MI, or stent thrombosis did not occur in both

The American Journal of Cardiology� APRIL 23e26, 2013 AN

groups during hospitalization. However, The cerebrovascular accidentoccurred in 1 patient in TAP group. The lower PRU and greater %inhibition also occurred with prasugrel than with TAP at 5-days afterPCI (107.6�59.91 vs. 235.4�87.93; 64.1�17.80% vs. 18.3�20.35%,p<0.001 respectively).

Conclusion: Our study presents that prasugrel has a greater peri-procedural as well as in-hospital IPA compared with TAP in patientswith STEMI.

- AS-134

Platelet Function Tests Variability Study. Ho Lam,Kowk Kit Yeung, Yam Hong Wong, Kowk Chun Ko, Yu Ho Chan,Wei Fung Leung, Ka Lung Chui, Chi Wing Wong, Sze Fai Yip,Man Lok Wong, Ping Wah Yam, Cheuk Sum Lam. Tuen Mun Hospital,Tuen Mun, Hong Kong, China.

Background: Antiplatelet treatment failure leads to increase clinicalevents for patients undergoing PCI. Checking antiplatelet treatmentefficacy before PCI to tailor the drug dosage becomes more and morepopular. However, most of the studies are done with one plateletfunction test only. Comparison between different tests to check theirconsistency has not been well studied. Recently, a POPular〃 Trialhas studied different point of care antiplatelet function tests. Itshows that some platelet function tests cannot demonstrate predictivevalue.

Methods: This is a prospective observational trial to test consistencybetween different platelet function tests from the most popular point forcare VerifyNow, to most well-accepted flow cytometry measurement ofvasodilator-stimulated phosphoprotein phosphorylation (VASP) and thenew WBA platelet function test (Whole Blood Impedance Aggregom-etry). 31 consecutive patients undergoing elective PCI in Tuen MunHospital from 11/2011 to 12/2011 are selected for 3 different plateletfunction tests with written consent after elective PCI. All patients aretreated with aspirin 160mg and clopidogrel 300mg loading plus 75mgmaintenance. 20 healthy subjects (11 male and 9 female) were used toset up normal range.

Results: By verify now, patients (n¼31) show PRU 81-348. If wetake PRU> 230 as cutoff, 54.8 % (n¼17) patients are non responder.By VASP, patients (n¼31) show PRI 25.5 -83.7. If we take PRI>50 ascutoff, 37.7% (n¼21) patients are non responder. By WBA usingcollagen as platelet agonist, patients (n¼23) shows 6 minutes imped-ance 2-19. If we take >10 as cutoff value, 28.6% (n¼6) patients are nonresponder. Comparison between VASP and Verify Now (n¼31) finds61.3% (n¼19) patients showing consistent result between the two tests,namely 38.7% inconsistency. Among 21 patients tested by all the3 tests, only 28.6% (n¼6) patients show consistent results between thetests.

Conclusion: This small study demonstrates the problem of inconsis-tency between different platelet function tests results, which may affectthe clinical usage and it urges the need for searching a gold standard inplatelet function test in the future, especially after GRAVITAS Trial. It isalarming to find high prevalence of plavix non responder in our localpopulation undergoing PCI.

GIOPLASTY SUMMIT ABSTRACTS/Oral 11B