Abstract 15617

In-Stent RestenosisIdentification of a New Marker by Thrombelastography

Bliden, Kevin P
Gesheff, Martin G
Franzese, Christopher J
Pandya, Shachi
Toth, Peter P
Tantry, Udaya S
Gurbel, Paul A

¹Sinai Cntr for Thrombosis Rsch, Sinai Hosp Baltimore, Baltimore, MD
²Clinical Family and Community Medicine, Univ of Illinois College of Medicine, Peoria, IL

Author Disclosures: K.P. Bliden: None. M.G. Gesheff: None. C.J. Franzese: None. S. Pandya: None. P.P. Toth: None. U.S. Tantry: None. P.A. Gurbel: Research Grant; Significant; National Institutes of Health, Daiichi Sankyo/Lilly, CSL, AstraZeneca, , Harvard Clinical Research Institute, Bayer, Haemonetics and Duke Clinical Research Institute, Sinnowa, Coramed, Multiplate. Other Research Support; Modest; Accumetrics,. Speakers Bureau; Significant; AstraZeneca, Daiichi Sankyo/ Lilly, Merck. Honoraria; Modest; Boehringer Ingleheim. Honoraria; Significant; AstraZeneca, Daiichi Sankyo/ Lilly, Merck. Consultant/Advisory Board; Significant; AstraZeneca, Daiichi Sankyo/ Lilly, Merck, Accumetrics,.

Circulation 130(Suppl_2):p A15617, November 25, 2014.

Background: In-stent restenosis (ISR) is a limitation of coronary stenting with frequencies dependent on stent type (3-11%). ISR risk is largely associated with clinical and angiographic variables. The simultaneous assessment of biomarkers linked to thrombosis, inflammation, and lipid status to identify patients at high risk for ISR has never been reported.

Methods: Clinical, lifestyle, angiographic, and biomarker measures were determined in 170 patients (pts) with a history of successful coronary stenting scheduled for elective angiography for suspicion of stent restenosis. Thromboelastography, conventional platelet aggregation (PA), detailed lipid profiling, urinary 11-dehydrothromboxane B2, and AtherOx were determined immediately prior to catheterization. Restenosis was defined as >50% luminal diameter obstruction.

Results: Sixty-nine pts (41%) had ISR and among those, forty pts (58%) had multiple ISRs. Pts with ISR were more frequently female (38% vs. 22%, p=0.04), had significantly higher thrombin-induced platelet-fibrin clot strength (TIP-FCS) (69.9mm vs. 65.6mm, p<0.001), and a higher ApoB/A1 ratio (0.65 vs. 0.59, p=0.03) compared to pts without ISR. In pts on dual antiplatelet therapy (n=86) there was no difference in ADP-, AA-, and collagen-induced PA between groups. By multivariate analysis, only TIP-FCS was associated with ISR (p<0.001). By ROC analysis, TIP-FCS more than 67mm had the best predictive value of ISR (AUC=0.80, p<0.0001). The proportion of pts with ISR increased with TIP-FCS quartiles (figure).

Conclusion: We report the largest comprehensive assessment of the hemostatic profile in patients with ISR. Patients with ISR have a prothrombotic phenotype. TIP-FCS as measured by thrombelastography is a promising novel marker of ISR. Further studies of TIP-FCS in a larger dataset to confirm prognostic utility and for potentially personalizing either antithrombotic or antiproliferative (stent-based) therapy are warranted.