Geoffrey A Rubin1, Ajay J Kirtane1,2, Shmuel Chen1,2, Björn Redfors1,2,3, Giora Weisz2,4, Usman Baber5, Yiran Zhang2, Thomas D Stuckey6, Bernhard Witzenbichler7, Michael J Rinaldi8, Franz-Josef Neumann9, D Christopher Metzger10, Timothy D Henry11,12, David A Cox13, Peter L Duffy14, Bruce R Brodie6, Ernest L Mazzaferri15, Roxana Mehran2,5, Ziad A Ali1,2, Ori Ben-Yehuda1,2, Gregg W Stone2,5. 1. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York. 2. Clinical Trails Center, Cardiovascular Research Foundation, New York, New York. 3. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 4. Montefiore Medical Center, Bronx, New York. 5. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 6. LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, North Carolina. 7. Helios Amper-Klinikum, Dachau, Germany. 8. Sanger Heart and Vascular Institute/Atrium Health, Charlotte, North Carolina. 9. Heart Center, University of Freiburg, Bad Krozingen, Germany. 10. Ballad Health CVA Heart Institute, Kingsport, Tennessee. 11. The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio. 12. Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota. 13. CVA Brookwood Baptist Hospital, Birmingham, Alabama. 14. Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, North Carolina. 15. The Ohio State University Wexner Medical Center, Columbus, Ohio.
Abstract
OBJECTIVES: We sought to compare clinical outcomes after percutaneous coronary intervention (PCI) in patients on versus not on hemodialysis (HD) and examine whether high on-treatment platelet reactivity (HPR) further impacts outcomes among patients on HD. BACKGROUND: Both chronic kidney disease (CKD) and HPR are predictors of major adverse cardiac events (MACE) after PCI. METHODS: Two-year outcomes of patients from the prospective, multicenter ADAPT-DES study (N = 8,582) were analyzed according to HD status at enrollment. All patients underwent platelet function testing with the VerifyNow assay; HPR on clopidogrel was defined as P2Y12 reaction units (PRU) >208. RESULTS: Compared with non-HD patients, patients on HD (n = 85) had significantly higher baseline PRU (median 254 vs. 188, p = .001) and more frequently had HPR (61.7% vs. 42.5%, p < .001). HD was associated with increased 2-year rates of MACE (death, myocardial infarction (MI) or definite stent thrombosis (ST); 23.4% vs. 10.7%, p < .001). HD was also strongly associated with 2-year overall mortality, cardiac death, MI, target vessel revascularization, major bleeding, stroke and ST. Following adjustment for HPR and other covariates, HD was independently associated with overall mortality, MI, ST, and major bleeding at 2 years. The relationship between HD status and 2-year MACE was consistent in patients with and without HPR (Pinteraction = .78). CONCLUSIONS: Nearly two-thirds of patients on HD exhibited HPR on clopidogrel, and both HD and HPR were independently associated with 2-year adverse outcomes after DES implantation. However, the deleterious impact of HD on clinical outcomes was present in both patients with and without HPR.
OBJECTIVES: We sought to compare clinical outcomes after percutaneous coronary intervention (PCI) in patients on versus not on hemodialysis (HD) and examine whether high on-treatment platelet reactivity (HPR) further impacts outcomes among patients on HD. BACKGROUND: Both chronic kidney disease (CKD) and HPR are predictors of major adverse cardiac events (MACE) after PCI. METHODS: Two-year outcomes of patients from the prospective, multicenter ADAPT-DES study (N = 8,582) were analyzed according to HD status at enrollment. All patients underwent platelet function testing with the VerifyNow assay; HPR on clopidogrel was defined as P2Y12 reaction units (PRU) >208. RESULTS: Compared with non-HD patients, patients on HD (n = 85) had significantly higher baseline PRU (median 254 vs. 188, p = .001) and more frequently had HPR (61.7% vs. 42.5%, p < .001). HD was associated with increased 2-year rates of MACE (death, myocardial infarction (MI) or definite stent thrombosis (ST); 23.4% vs. 10.7%, p < .001). HD was also strongly associated with 2-year overall mortality, cardiac death, MI, target vessel revascularization, major bleeding, stroke and ST. Following adjustment for HPR and other covariates, HD was independently associated with overall mortality, MI, ST, and major bleeding at 2 years. The relationship between HD status and 2-year MACE was consistent in patients with and without HPR (Pinteraction = .78). CONCLUSIONS: Nearly two-thirds of patients on HD exhibited HPR on clopidogrel, and both HD and HPR were independently associated with 2-year adverse outcomes after DES implantation. However, the deleterious impact of HD on clinical outcomes was present in both patients with and without HPR.
Authors: Lucas B Cofer; Qandeel H Soomro; Yuhe Xia; Elliot Luttrell-Williams; Khrystyna Myndzar; David M Charytan; Jeffrey S Berger Journal: Kidney Int Rep Date: 2022-08-04