Abstract 2363: Effect Of Aspirin And Clopidogrel Resistance On Myonecrosis Following Percutaneous Coronary Intervention
Bibliographic record
Abstract
Background: The presence of aspirin and clopidogrel resistance is increasingly recognized. We seek to evaluate if patients with aspirin and/or clopidogrel resistance are predisposed to myonecrosis following percutaneous coronary interventions (PCI). Methods: This study is performed as a substudy of the Brief-PCI, which randomized 620 patients to 18hr or 2hr infusion of eptifibatide following PCI. To be eligible for our substudy, patients have to be pretreated with aspirin (≥5 days) and clopidogrel (either 75mg/d ≥5 days, or 300mg loading ≥6 hr), and have not received a glycoprotein IIb/IIIa inhibitor within the past 48hrs. Bedside point-of-care platelet aggregometry using Accumetrics VerifyNow™ Aspirin and Clopidogrel assays were performed at baseline prior to PCI. Patients with aspirin reaction unit (ARU) ≥550 were labeled as “aspirin resistant”. Patients with percent inhibition ≤20% on the VerifyNow™ Clopidogrel assays were labeled as “clopidogrel resistant”. Our primary endpoint is the prevalence of myonecrosis within 24hrs post-PCI (defined as elevation of Troponin I >1μg/L when baseline levels are negative, or peak CK-MB >3 times upper limit of normal and >50% higher than baseline value). Results: We enrolled 203 patients, of which 181 had aspirin resistance assessed, 188 had clopidogrel resistance assessed, and 169 had both assessed. There were 5% ± 1.6% who were aspirin resistant, 29% ± 3.3% who were clopidogrel resistant, and 1% ± 0.8% who were resistant to both. The overall prevalence of myonecrosis within 24hrs of PCI was 9% ± 2%. Patients who were resistant to both aspirin and clopidogrel had a higher prevalence of myonecrosis compared to those who had normal response (50% vs. 8%, p=0.031). There was no difference in myonecrosis prevalence among aspirin resistant patients compared to those with normal aspirin response (11% vs. 8%, p=0.754), or among clopidogrel resistant patients compared to those with normal clopidogrel response (11% vs. 7%, p=0.390). The mean ARU and percent inhibition was not different between those with or without myonecrosis. Conclusion: Our data suggests that only a small proportion of patients were resistant to both aspirin and clopidogrel, and these patients may have a higher prevalence of myonecrosis following PCI.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".