High platelet reactivity affects the clinical outcomes of patients undergoing percutaneous coronary intervention

Jun-Jie Zhang, Xiao-Fei Gao, Zhen Ge, Nai-Liang Tian, Zhi-Zhong Liu, Song Lin, Fei Ye, Shao-Liang Chen, Jun-Jie Zhang, Xiao-Fei Gao, Zhen Ge, Nai-Liang Tian, Zhi-Zhong Liu, Song Lin, Fei Ye, Shao-Liang Chen

Abstract

Background: The association of platelet reactivity and clinical outcomes, especially stent thrombosis, was not so clear. We sought to investigate whether high platelet reactivity affects clinical outcomes of patients with drug eluting stents (DESs) implantation.

Methods: All enrolled individuals treated with DESs implantation were evaluated by PL-11, using sequentially platelet counting method. The primary end point was the occurrence of definite and probable stent thrombosis at 2 years. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all cause death, spontaneous myocardial infarction (MI), target vessel revascularization (TVR), and ischemic stroke.

Results: A total of 1331consecutive patients were enrolled at our center. There were 91 patients (6.8 %) identified with high platelet reactivity (HPR) on aspirin, and 437 patients (32.9 %) with HPR on clopidogrel. At 2-year follow-up, the incidence of stent thrombosis was significantly higher in patients with HPR on aspirin (9.9 % vs. 0.4 %, p < 0.001), and HPR on clopidogrel (3.0 % vs. 0.1 %, p < 0.001). There were increased MACCE in the HPR on aspirin group (16.5 % vs. 8.5 %, p = 0.021), mainly driven by the higher all cause death (7.7 % vs. 1.6 %, p = 0.002) and MI (9.9 % vs. 1.9 %, p < 0.001) in the HPR on aspirin group. Similarly, the rate of MACCE was higher in the HPR on clopidogrel group (12.4 % vs. 7.4 %, p = 0.004). No differences in all bleeding and hemorrhagic stroke were observed.

Conclusions: The present study demonstrated that high platelet reactivity on both aspirin and clopidogrel were associated with incremental stent thrombosis following DESs implantation.

Keywords: Drug eluting stent; High platelet reactivity; Platelet function test; Stent thrombosis.

Figures

Fig. 1
Fig. 1
Flowchart of study design. The value of ADP-MAR% was missed in three patients. AA: arachidonic acid; MAR: maximal aggregation ratio; ADP: adenosine diphosphate
Fig. 2
Fig. 2
Definite/ probable stent thrombosis-free survival rate at 2 years. Freedom from definite/probable stent thrombosis at 2-year follow-upa between AA-MAR% ≥ 30 % (green line) and AA-MAR% < 30 % (blue line), b between ADP-MAR% ≥ 55 % (green line) and ADP-MAR% < 55 % (blue line). Abbreviations are showed in Fig. 1
Fig. 3
Fig. 3
MACCE-free survival rate at 2 years. Freedom from adverse cardiovascular and cerebrovascular events at 2-year follow-up a between AA-MAR% ≥ 30 % (green line) and AA-MAR% < 30 % (blue line), b between ADP-MAR% ≥ 55 % (green line) and ADP-MAR% < 55 % (blue line). Abbreviations are showed in Fig. 1

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Source: PubMed

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