TY - JOUR
T1 - Platelet Reactivity and Risk of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation
T2 - From the ADAPT-DES Study
AU - Giustino, Gennaro
AU - Redfors, Björn
AU - Kirtane, Ajay J.
AU - Mehran, Roxana
AU - Dangas, George D.
AU - Witzenbichler, Bernhard
AU - Neumann, Franz Josef
AU - Weisz, Giora
AU - Généreux, Philippe
AU - Maehara, Akiko
AU - McAndrew, Thomas
AU - Farhan, Serdar
AU - Rinaldi, Michael J.
AU - Metzger, D. Christopher
AU - Henry, Timothy D.
AU - Cox, David A.
AU - Duffy, Peter L.
AU - Mazzaferri, Ernest L.
AU - Brodie, Bruce R.
AU - Stuckey, Thomas D.
AU - Gurbel, Paul
AU - Ben-Yehuda, Ori
AU - Stone, Gregg W.
N1 - Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/7/9
Y1 - 2018/7/9
N2 - Objectives: The authors sought to investigate the association between P2Y12 reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. Background: The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. Methods: Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. Results: Among 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y12 receptor inhibition; 2-year rate of 0.51%) to the highest quintile of PRU (less P2Y12 receptor inhibition; 2-year rate of 1.34%; adjusted p = 0.04). PRU >208 was independently associated with higher risk of IS at 2 years (adjusted hazard ratio 1.81; 95% confidence interval 1.08 to 3.04; p = 0.03). The association between higher PRU and risk for IS was also consistent in patients with versus without high CHA2DS2-VASc score (pinteraction = 0.30) and in those on or off oral anticoagulation at discharge (pinteraction = 0.99). Occurrence of IS was strongly associated with increased risk of all-cause mortality at 2 years (adjusted HR: 4.16; 95% CI: 1.95 to 8.87; p < 0.0001). Conclusions: Higher PRU was associated with increased risk of IS after coronary DES implantation. Ensuring adequate platelet P2Y12 receptor inhibition may reduce the risk of IS in this patient population.
AB - Objectives: The authors sought to investigate the association between P2Y12 reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. Background: The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. Methods: Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. Results: Among 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y12 receptor inhibition; 2-year rate of 0.51%) to the highest quintile of PRU (less P2Y12 receptor inhibition; 2-year rate of 1.34%; adjusted p = 0.04). PRU >208 was independently associated with higher risk of IS at 2 years (adjusted hazard ratio 1.81; 95% confidence interval 1.08 to 3.04; p = 0.03). The association between higher PRU and risk for IS was also consistent in patients with versus without high CHA2DS2-VASc score (pinteraction = 0.30) and in those on or off oral anticoagulation at discharge (pinteraction = 0.99). Occurrence of IS was strongly associated with increased risk of all-cause mortality at 2 years (adjusted HR: 4.16; 95% CI: 1.95 to 8.87; p < 0.0001). Conclusions: Higher PRU was associated with increased risk of IS after coronary DES implantation. Ensuring adequate platelet P2Y12 receptor inhibition may reduce the risk of IS in this patient population.
KW - drug-eluting stent(s)
KW - percutaneous coronary intervention
KW - platelet reactivity
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85048149621&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2018.01.263
DO - 10.1016/j.jcin.2018.01.263
M3 - Article
C2 - 29908967
AN - SCOPUS:85048149621
SN - 1936-8798
VL - 11
SP - 1277
EP - 1286
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 13
ER -