The STIB score: a simple clinical test to predict clopidogrel resistance

D. Legrand; E. Barbato; P. Chenu; J. Magne; M. Vrolix; W. Wijns; V. Legrand

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Document Details :

Title: The STIB score: a simple clinical test to predict clopidogrel resistance
Author(s): D. Legrand , E. Barbato , P. Chenu , J. Magne , M. Vrolix , W. Wijns , V. Legrand
Journal: Acta Cardiologica
Volume: 70 Issue: 5 Date: 2015
Pages: 516-521
DOI: 10.2143/AC.70.5.3110511

Abstract :
Background: High platelet reactivity (HPR) to clopidogrel is associated with an increased risk of ischaemic complications during and after coronary interventions and concerns up to 50% of patients undergoing PCI.
Aim of the study: The aim of the study was to identify patients with HPR to clopidogrel using bedside clinical information obtained in the Stent Thrombosis In Belgium (STIB) trial.
Methods: Data on platelet reactivity using the VerifyNow^® point-of-care assay were obtained in 844 patients undergoing PCI for stable coronary artery disease 12 to 24 hours after a 600-mg loading dose of clopidogrel was given. Demographic, clinical and baseline routine biological tests were obtained and compared with P2Y12 reaction units (PRU). Patients with PRU > 230 (HPR) were considered as non-responders to clopidogrel.
Results: HPR was observed in 424/844 pts. Age, weight, body mass index (BMI), HPR to aspirin, diabetes, renal failure (MDRD < 60 ml/min), haemoglobin (Hb), haematocrit, fibrinogen, glycaemia and glycated haemoglobin were associated with HPR to clopidogrel. In multivariate analysis, only Hb (OR: 0.77), BMI (OR: 1.06) and diabetes (OR: 1.62) emerged as independent risk factors. Hb < 13.9 g/dl, BMI > 28 kg/m² and presence of diabetes were equally associated to predict HPR and can be added to derive a simple score to predict clopidogrel resistance. Although 38.5% of patients without a single clinical predictor still have HPR, 2/3 patients with 2 or 3 risk factors are resistant to clopidogrel.
Conclusions: STIB HPR score allows identification of patients with a high probability of resistance to clopidogrel based on diabetes, Hb < 13.9 g/dl and BMI > 28 kg/m². This bedside clinical test could be useful for the identification of patients in whom another P2Y12 inhibitor should be recommended before and after PCI.