TY - JOUR
T1 - Impact of high on-treatment platelet reactivity on outcomes following PCI in patients on hemodialysis
T2 - An ADAPT-DES substudy
AU - Rubin, Geoffrey A.
AU - Kirtane, Ajay J.
AU - Chen, Shmuel
AU - Redfors, Björn
AU - Weisz, Giora
AU - Baber, Usman
AU - Zhang, Yiran
AU - Stuckey, Thomas D.
AU - Witzenbichler, Bernhard
AU - Rinaldi, Michael J.
AU - Neumann, Franz Josef
AU - Metzger, D. Christopher
AU - Henry, Timothy D.
AU - Cox, David A.
AU - Duffy, Peter L.
AU - Brodie, Bruce R.
AU - Mazzaferri, Ernest L.
AU - Mehran, Roxana
AU - Ali, Ziad A.
AU - Ben-Yehuda, Ori
AU - Stone, Gregg W.
N1 - Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - OBJECTIVES: We sought to compare clinical outcomes after percutaneous coronary intervention (PCI) in patients on versus not on hemodialysis (HD) and examine whether high on-treatment platelet reactivity (HPR) further impacts outcomes among patients on HD. BACKGROUND: Both chronic kidney disease (CKD) and HPR are predictors of major adverse cardiac events (MACE) after PCI. METHODS: Two-year outcomes of patients from the prospective, multicenter ADAPT-DES study (N = 8,582) were analyzed according to HD status at enrollment. All patients underwent platelet function testing with the VerifyNow assay; HPR on clopidogrel was defined as P2Y12 reaction units (PRU) >208. RESULTS: Compared with non-HD patients, patients on HD (n = 85) had significantly higher baseline PRU (median 254 vs. 188, p =.001) and more frequently had HPR (61.7% vs. 42.5%, p <.001). HD was associated with increased 2-year rates of MACE (death, myocardial infarction (MI) or definite stent thrombosis (ST); 23.4% vs. 10.7%, p <.001). HD was also strongly associated with 2-year overall mortality, cardiac death, MI, target vessel revascularization, major bleeding, stroke and ST. Following adjustment for HPR and other covariates, HD was independently associated with overall mortality, MI, ST, and major bleeding at 2 years. The relationship between HD status and 2-year MACE was consistent in patients with and without HPR (Pinteraction =.78). CONCLUSIONS: Nearly two-thirds of patients on HD exhibited HPR on clopidogrel, and both HD and HPR were independently associated with 2-year adverse outcomes after DES implantation. However, the deleterious impact of HD on clinical outcomes was present in both patients with and without HPR.
AB - OBJECTIVES: We sought to compare clinical outcomes after percutaneous coronary intervention (PCI) in patients on versus not on hemodialysis (HD) and examine whether high on-treatment platelet reactivity (HPR) further impacts outcomes among patients on HD. BACKGROUND: Both chronic kidney disease (CKD) and HPR are predictors of major adverse cardiac events (MACE) after PCI. METHODS: Two-year outcomes of patients from the prospective, multicenter ADAPT-DES study (N = 8,582) were analyzed according to HD status at enrollment. All patients underwent platelet function testing with the VerifyNow assay; HPR on clopidogrel was defined as P2Y12 reaction units (PRU) >208. RESULTS: Compared with non-HD patients, patients on HD (n = 85) had significantly higher baseline PRU (median 254 vs. 188, p =.001) and more frequently had HPR (61.7% vs. 42.5%, p <.001). HD was associated with increased 2-year rates of MACE (death, myocardial infarction (MI) or definite stent thrombosis (ST); 23.4% vs. 10.7%, p <.001). HD was also strongly associated with 2-year overall mortality, cardiac death, MI, target vessel revascularization, major bleeding, stroke and ST. Following adjustment for HPR and other covariates, HD was independently associated with overall mortality, MI, ST, and major bleeding at 2 years. The relationship between HD status and 2-year MACE was consistent in patients with and without HPR (Pinteraction =.78). CONCLUSIONS: Nearly two-thirds of patients on HD exhibited HPR on clopidogrel, and both HD and HPR were independently associated with 2-year adverse outcomes after DES implantation. However, the deleterious impact of HD on clinical outcomes was present in both patients with and without HPR.
KW - drug-eluting stents
KW - hemodialysis
KW - high platelet reactivity
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85075220011&partnerID=8YFLogxK
U2 - 10.1002/ccd.28577
DO - 10.1002/ccd.28577
M3 - Article
C2 - 31721430
AN - SCOPUS:85075220011
SN - 1522-1946
VL - 96
SP - 793
EP - 801
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -