Rajesh Gupta1, Ajay J Kirtane2, M Ozgu Ozan1, Bernhard Witzenbichler1, Michael J Rinaldi1, D Christopher Metzger1, Giora Weisz1, Thomas D Stuckey1, Bruce R Brodie1, Roxana Mehran1, Ori Ben-Yehuda1, Gregg W Stone1. 1. From the University of Toledo Medical Center, OH (R.G.); Cardiovascular Research Foundation, New York, NY (A.J.K., M.O.O., G.W., R.M., O.B.-Y., G.W.S.); NewYork-Presbyterian Hospital/Columbia University Medical Center, NY (A.J.K., G.W., O.B.-Y., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC (T.D.S., B.R.B.); and Icahn School of Medicine at Mount Sinai, New York, NY (R.M.). 2. From the University of Toledo Medical Center, OH (R.G.); Cardiovascular Research Foundation, New York, NY (A.J.K., M.O.O., G.W., R.M., O.B.-Y., G.W.S.); NewYork-Presbyterian Hospital/Columbia University Medical Center, NY (A.J.K., G.W., O.B.-Y., G.W.S.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Sanger Heart & Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, NC (T.D.S., B.R.B.); and Icahn School of Medicine at Mount Sinai, New York, NY (R.M.). akirtane@columbia.edu.
Abstract
BACKGROUND: Patients with peripheral arterial disease (PAD) have high rates of adverse cardiovascular events after percutaneous coronary intervention and may additionally have heightened platelet reactivity. This study assessed the relationship between platelet reactivity and clinical outcomes after percutaneous coronary interventions among subjects with and without PAD. METHODS AND RESULTS: 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 PAD, platelet reactivity, and subsequent adverse events (definite or probable stent thrombosis, all-cause mortality, myocardial infarction, and clinically relevant bleeding). Among 8582 patients, 10.2% had a history of PAD. Patients with PAD were older and more likely to have comorbid conditions; however, mean P2Y12 reaction units and HPR were not significantly different between PAD and no PAD groups. Patients with PAD had higher 2-year rates of all-cause mortality, myocardial infarction, stent thrombosis, and clinically relevant bleeding. Associations between HPR and adverse events were similar in PAD and no PAD groups, without evidence of interaction; however, adverse event rates were highest among subjects with both PAD and HPR. In a propensity-adjusted multivariable model, both PAD and HPR were independent predictors of myocardial infarction at 2 years. CONCLUSIONS: A history of PAD was associated with ischemic and bleeding outcomes 2 years after successful coronary drug-eluting stent implantation; however, these associations did not seem to be directly mediated by heightened platelet reactivity. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
BACKGROUND:Patients with peripheral arterial disease (PAD) have high rates of adverse cardiovascular events after percutaneous coronary intervention and may additionally have heightened platelet reactivity. This study assessed the relationship between platelet reactivity and clinical outcomes after percutaneous coronary interventions among subjects with and without PAD. METHODS AND RESULTS: 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 PAD, platelet reactivity, and subsequent adverse events (definite or probable stent thrombosis, all-cause mortality, myocardial infarction, and clinically relevant bleeding). Among 8582 patients, 10.2% had a history of PAD. Patients with PAD were older and more likely to have comorbid conditions; however, mean P2Y12 reaction units and HPR were not significantly different between PAD and no PAD groups. Patients with PAD had higher 2-year rates of all-cause mortality, myocardial infarction, stent thrombosis, and clinically relevant bleeding. Associations between HPR and adverse events were similar in PAD and no PAD groups, without evidence of interaction; however, adverse event rates were highest among subjects with both PAD and HPR. In a propensity-adjusted multivariable model, both PAD and HPR were independent predictors of myocardial infarction at 2 years. CONCLUSIONS: A history of PAD was associated with ischemic and bleeding outcomes 2 years after successful coronary drug-eluting stent implantation; however, these associations did not seem to be directly mediated by heightened platelet reactivity. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
Authors: Wayne Batchelor; David E Kandzari; Scott Davis; Luis Tami; John C Wang; Islam Othman; Osvaldo S Gigliotti; Amir Haghighat; Sarabjeet Singh; Mario Lopez; Gregory Giugliano; Phillip A Horwitz; Jaya Chandrasekhar; Paul Underwood; Craig A Thompson; Roxana Mehran Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676