A HANC Risk Stratification Score for Antiplatelet Therapy Optimization with Low-Dose Prasugrel in Taiwanese Acute Coronary Syndrome Patients from the Switch Study

Wen Lieng Lee, Yi Chih Wang, Chieh Shou Su, Hsin Fu Lee, Ying Chang Tung, Ping Yen Liu, Cheng Huang Su, Feng Yu Kuo, Wei Shiang Lin, Pao Hsien Chu, Tse Min Lu, Ping Han Lo, Shuji Tsukiyama, Wei Chen Yang, Li Chung Cheng, Wei Hsian Yin, Yen Hung Lin

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: A significant proportion of acute coronary syndrome (ACS) patients experience high on-treatment platelet reactivity (HPR) on clopidogrel-based dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Objectives: This study assessed key independent risk factors associated with significant HPR risk on clopidogrel, but not prasugrel, in the Switch Study cohort of 200 Taiwanese ACS patients who switched from clopidogrel to low-dose prasugrel for maintenance DAPT after PCI. Methods: Univariate analysis and stepwise multivariate logistic regression analysis were conducted to identify key independent risk factors for HPR on clopidogrel, but not prasugrel. Results: A HANC [H: low hemoglobin (< 13 g/dL for men and < 12 g/dL for women); A: age 65 years; N: non-ST elevation myocardial infarction; C: chronic kidney disease as defined by estimated glomerular filtration rate < 60 mL/min] risk stratification score was developed, and demonstrated optimal sensitivity and specificity at a cutoff score of 2. The HANC score compared favorably against the recently validated ABCD score in the full Switch Study cohort (n = 200), and the ABCD-GENE score in a genotyped cohort (n = 102). Conclusions: The HANC score may serve to alert clinicians to patients at potentially higher HPR risk on clopidogrel, but not prasugrel. Further research to validate this score and assess its correlation with clinical outcomes is warranted.

Original languageEnglish
Pages (from-to)751-764
Number of pages14
JournalActa Cardiologica Sinica
Volume38
Issue number6
DOIs
Publication statusPublished - 2022 Nov

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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