TY - JOUR
T1 - Impact of Point-of-Care Platelet Function Testing Among Patients With and Without Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents (from the ADAPT-DES Study)
AU - Rinaldi, Michael J.
AU - Gohs, Frank X.
AU - Kirtane, Ajay J.
AU - Brodie, Bruce R.
AU - Stuckey, Thomas D.
AU - Redfors, Björn
AU - McAndrew, Thomas
AU - Witzenbichler, Bernhard
AU - Weisz, Giora
AU - Neumann, Franz Josef
AU - Metzger, D. Christopher
AU - Maehara, Akiko
AU - Généreux, Philippe
AU - Mehran, Roxana
AU - Stone, Gregg W.
N1 - Publisher Copyright:
© 2018
PY - 2019/2/15
Y1 - 2019/2/15
N2 - We sought to examine if the risk conferred by high on-treatment platelet reactivity (HPR) varies based upon clinical presentation. We examined the relation between HPR (P2Y12 reaction units >208) and adverse ischemic and bleeding events among patients with and without acute coronary syndromes (ACS) from ADAPT-DES; 51.7% of patients had ACS. After clopidogrel loading, ACS patients had higher P2Y12 reaction units and a greater prevalence of HPR based on VerifyNow P2Y12 assay. Of 92 definite or probable stent thrombosis (ST) events at 2 years, 65.2% occurred among patients with ACS. HPR was independently associated with ST in ACS patients (adjusted hazard ratio 2.29, 95% confidence interval 1.32 to 3.98) but not with clinically relevant bleeding. Although no statistical interactions between ACS status and these associations were observed, non-ACS patients exhibited an attenuated association between HPR and ST, and an inverse association between HPR and clinically relevant bleeding. HPR was similarly associated with myocardial infarction, but not with overall mortality in ACS and non-ACS patients. In conclusion, the majority of ST events in the 2 years after drug-eluting stent placement occurred in ACS patients; HPR was strongly associated with ST in these patients. These data support current recommendations for using more potent antiplatelet therapies in ACS patients.
AB - We sought to examine if the risk conferred by high on-treatment platelet reactivity (HPR) varies based upon clinical presentation. We examined the relation between HPR (P2Y12 reaction units >208) and adverse ischemic and bleeding events among patients with and without acute coronary syndromes (ACS) from ADAPT-DES; 51.7% of patients had ACS. After clopidogrel loading, ACS patients had higher P2Y12 reaction units and a greater prevalence of HPR based on VerifyNow P2Y12 assay. Of 92 definite or probable stent thrombosis (ST) events at 2 years, 65.2% occurred among patients with ACS. HPR was independently associated with ST in ACS patients (adjusted hazard ratio 2.29, 95% confidence interval 1.32 to 3.98) but not with clinically relevant bleeding. Although no statistical interactions between ACS status and these associations were observed, non-ACS patients exhibited an attenuated association between HPR and ST, and an inverse association between HPR and clinically relevant bleeding. HPR was similarly associated with myocardial infarction, but not with overall mortality in ACS and non-ACS patients. In conclusion, the majority of ST events in the 2 years after drug-eluting stent placement occurred in ACS patients; HPR was strongly associated with ST in these patients. These data support current recommendations for using more potent antiplatelet therapies in ACS patients.
UR - http://www.scopus.com/inward/record.url?scp=85057736119&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2018.11.026
DO - 10.1016/j.amjcard.2018.11.026
M3 - Article
C2 - 30527773
AN - SCOPUS:85057736119
SN - 0002-9149
VL - 123
SP - 549
EP - 557
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 4
ER -