Impact of Smoking on Platelet Reactivity and Clinical Outcomes after Percutaneous Coronary Intervention: Findings from the ADAPT-DES Study

Rajesh Gupta, Ajay J. Kirtane, Yangbo Liu, Aaron Crowley, Bernhard Witzenbichler, Michael J. Rinaldi, D. Christopher Metzger, Giora Weisz, Thomas D. Stuckey, Bruce R. Brodie, Roxana Mehran, Ori Ben-Yehuda, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: Smoking is a potent risk factor for coronary artery disease; however, prior studies describe increased platelet inhibition with clopidogrel among smokers, and some studies report improved outcomes among smokers, a finding described as the smoker's paradox. This study assessed the relationship between platelet reactivity and clinical outcomes after percutaneous coronary interventions among current smokers and nonsmokers. Methods: ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, multicenter registry of patients treated with coronary drug-eluting stents. Platelet reactivity was assessed by the VerifyNow point-of-care assay; high on-treatment platelet reactivity (HPR) was defined as P2Y12 reaction units >208. A propensity-adjusted multivariable analysis was performed to determine the relationship between current smoking, platelet reactivity, and subsequent adverse events. Results: Among 8582 patients, 22.6% were active smokers at the time of their percutaneous coronary intervention procedure. Current smokers were younger and had fewer comorbidities compared with nonsmokers. Current smokers had lower mean P2Y12 reaction units and lower rates of HPR compared with nonsmokers. Current smokers had similar rates of adverse events compared with nonsmokers. HPR was associated with higher rates of adverse events for both smokers and nonsmokers; however, there was evidence of interaction between smoking status and the effect of HPR. Smokers with HPR had significantly higher rates of stent thrombosis. Adverse event rates were highest among current smokers with HPR. Conclusions: Current smoking was associated with lower P2Y12 reaction units and lower rates of HPR on average; however, the combination of current smoking and HPR was associated with high rates of stent thrombosis.

Original languageEnglish
Article numbere007982
JournalCirculation: Cardiovascular Interventions
Volume12
Issue number11
DOIs
StatePublished - 1 Nov 2019

Keywords

  • cigarette smoking
  • coronary artery disease
  • percutaneous coronary intervention
  • platelet function tests
  • stents
  • thrombosis

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