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Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation: Results From the PTRG-DES Consortium

https://doi.org/10.1016/j.jcin.2022.09.007Get rights and content
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Abstract

Background

The long-term prognostic implication of platelet reactivity after percutaneous coronary intervention (PCI) is not clearly known.

Objectives

The impacts of platelet reactivity from the PTRG-DES consortium were assessed.

Methods

The primary endpoint was the major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, myocardial infarction, stent thrombosis, or stroke. Key secondary endpoints were all-cause mortality, major bleeding, and net adverse clinical events (NACE), including MACCE and bleeding.

Results

Between 2003 and 2018, a total of 11,714 patients were enrolled and grouped into tertiles according to P2Y12 reaction units (PRUs): high PRUs (≥253), intermediate PRUs (188-252), and low PRUs (<188). The Kaplan-Meier (KM) estimates of the primary outcome were significantly different across the groups; the high-PRU group showed the highest MACCE rate at 5 years (12.9%, 11.1%, and 7.0% in high-, intermediate-, and low-PRU groups, respectively; P < 0.001), as well as at 1 year (P < 0.001). The high-PRU group had the greatest KM estimates of all-cause death (8.2%, 5.9%, and 3.7%, respectively; P < 0.001) at 5 years without significant differences of major bleeding, and resultant of a higher KM estimates of NACE (15.7%, 13.6%, and 9.7%, respectively; P < 0.001). A PRU ≥252, the best cutoff value, was strongly related to MACCE (HR: 1.39; 95% CI: 1.11-1.74; P = 0.003) and all-cause death at 5 years after PCI (HR: 1.42; 95% CI: 1.04-1.94; P = 0.026). The optimal cutoff value of aspirin reaction units predicting the MACCE occurrence was ≥414 and was significantly associated with 5-year MACCE occurrence or all-cause death (P < 0.001).

Conclusions

In this large-scale cohort, high PRU was significantly associated with occurrence of MACCE, all-death death, and NACE at 5 years, as well as 1 year after PCI. (PTRG-DES Consortium [PTRG]; NCT04734028)

Key Words

drug-eluting stent(s)
percutaneous coronary intervention
platelet function tests
stent thrombosis

Abbreviations and Acronyms

ANOVA
analysis of variance
ARU
aspirin reaction unit
DAPT
dual antiplatelet therapy
DES
drug-eluting stent(s)
HPR
high platelet reactivity
MACCE
major adverse cardiac and cerebrovascular event(s)
MI
myocardial infarction
NACE
net adverse clinical event(s)
PCI
percutaneous coronary intervention
PFT
platelet function test
PRU
P2Y12 reaction unit
ST
stent thrombosis

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs S-J. Lee and Cha contributed equally to this work.