Impact of high on-treatment platelet reactivity on long-term clinical events in AMI patients: a fact or mirage?

Accumulating evidences have indicated the cut-offs for high on-treatment platelet reactivity (HPR) and low on-treatment platelet reactivity (LPR) that can be used in future trials for personalized antiplatelet therapy to balance clinical efficacy and safety (1, 2). However, recent prospective randomized trials using the current platelet function testing (PFT) did not demonstrate any clinical benefit (3–5). Consequently, it is unclear whether PFT-based treatment modification influences the outcomes of the therapy. Compared with patients with stable angina, platelet activation can be more closely related with thrombotic events among those with acute myocardial infarction (AMI) in the thrombogenic milieu (6). Furthermore, Jakl et al. (7) reported another evidence to show the impact of HPR on clinical events in AMI patients. This report may be of importance because it reveals the impact of HPR on longest-term (e.g., 5-year) adverse events in AMI patients using the readily available Multiplate® analyzer (8).