Usman Baber1, Roxana Mehran2, Ajay J Kirtane1, Paul A Gurbel1, Georgios Christodoulidis1, Akiko Maehara1, Bernhard Witzenbichler1, Giora Weisz1, Michael J Rinaldi1, D Christopher Metzger1, Timothy D Henry1, David A Cox1, Peter L Duffy1, Ernest L Mazzaferri1, Ke Xu1, Helen Parise1, Bruce R Brodie1, Thomas D Stuckey1, Gregg W Stone1. 1. From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork-Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (T.D.H.); Lehigh Valley Health Network, Allentown, PA (D.A.C.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); The Ohio State University Wexner Medical Center, Columbus (E.L.M.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.). 2. From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork-Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (T.D.H.); Lehigh Valley Health Network, Allentown, PA (D.A.C.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); The Ohio State University Wexner Medical Center, Columbus (E.L.M.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.). roxana.mehran@mssm.edu.
Abstract
BACKGROUND: Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. METHODS AND RESULTS: We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P<0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. CONCLUSIONS: HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
BACKGROUND:Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. METHODS AND RESULTS: We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P<0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. CONCLUSIONS: HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
Authors: Nishank Jain; Xilong Li; Beverley Adams-Huet; Ravi Sarode; Robert D Toto; Subhash Banerjee; S Susan Hedayati Journal: Am J Cardiol Date: 2015-12-07 Impact factor: 2.778
Authors: Constance C F M J Baaten; Jonas R Schröer; Jürgen Floege; Nikolaus Marx; Joachim Jankowski; Martin Berger; Heidi Noels Journal: Clin J Am Soc Nephrol Date: 2021-11-08 Impact factor: 8.237
Authors: Francesco Franchi; Stefan K James; Tatevik Ghukasyan Lakic; Andrzej J Budaj; Jan H Cornel; Hugo A Katus; Matyas Keltai; Frederic Kontny; Basil S Lewis; Robert F Storey; Anders Himmelmann; Lars Wallentin; Dominick J Angiolillo Journal: J Am Heart Assoc Date: 2019-03-19 Impact factor: 5.501