Adverse events in patients with high platelet reactivity following successful chronic total occlusion PCI: The Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study - 16/04/19
, Ajay J. Kirtane, MD, SM a, b, Philip Green, MD a, Thomas McAndrew, PhD b, Mengdan Liu, MS b, Michael B. Cloney, MD, MPH a, Bernhard Witzenbichler, MD d, Giora Weisz, MD e, Thomas D. Stuckey, MD f, Bruce R. Brodie, MD f, Michael J. Rinaldi, MD g, Franz-Josef Neumann, MD h, D. Christopher Metzger, MD i, Timothy D. Henry, MD j, k, David A. Cox, MD l, Peter L. Duffy, MD, MMM m, Ernest L. Mazzaferri, MD n, Roxana Mehran, MD b, o, Gregg W. Stone, MD a, bAbstract |
Background |
Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) typically requires a greater number of stents and longer stent length than non-CTO PCI, placing these patients at greater risk for adverse ischemic events. We sought to determine whether the association between high platelet reactivity (HPR) and the risk of ischemic events is stronger after CTO than non-CTO PCI.
Methods |
Patients undergoing successful PCI in the multicenter ADAPT-DES study were stratified according to whether they underwent PCI of a CTO. HPR was defined as VerifyNow platelet reaction units >208. The study primary endpoint was the 2-year risk target vessel failure ([TVF] defined as cardiac death, myocardial infarction, or target lesion revascularization).
Results |
CTO PCI was performed in 400 of 8448 patients. HPR was present in 34.5% of CTO PCI patients and 43.1% of non-CTO PCI patients (P = .0007). Patients undergoing CTO PCI with versus without HPR had significantly higher 2-year rates of TVF (15.0% versus 8.3%, P = .04) without significant differences in bleeding. HPR was an independent predictor of 2-year TVF (adjusted HR 1.16, 95% CI 1.02-1.34, P = .03) whereas CTO PCI was not (adjusted HR 0.89, 95% CI 0.65-1.22, P = .48). There was a significant interaction between CTO versus non-CTO PCI and PRU as a continuous variable for 2-year TVF (Pinteraction = 0.02).
Conclusions |
In ADAPT-DES, HPR was associated with an increased 2-year risk of TVF after PCI, an association that was at least as strong after CTO PCI compared with non-CTO PCI.
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| Disclosures: Dr Finn has no disclosures. Dr Karmpaliotis: speaker honoraria from Abbot Vascular, Boston Scientific, and Medtronic; consultant: Vascular Solutions. Dr Kirtane: Institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St Jude Medical, Vascular Dynamics, and Eli Lilly. Dr Green: NIH grant support K23HL121142-03. Dr Witzenbichler: Consultant – Volcano. Dr Weisz: Advisory board member of: Corindus, Filterlex, TriSol; institutional grant support: Abbott, CSI, Svelte. Dr Stuckey: Advisory board – Boston Scientific; speaker honoraria – Boston Scientific, Eli Lilly/Daiichi-Sankyo. Dr Rinaldi: Advisory board – Abbott Vascular, Boston Scientific, Edwards Lifesciences. Dr Cox: Consultant – Abbott Vascular, Boston Scientific Corporation, Medtronic. Dr Duffy: Consultant/speaker – Philips Medical/Volcano Corporation. Dr Mehran: Institutional research grant support – Eli Lilly/Daiichi-Sankyo, Inc., Bristol-Myers Squibb, AstraZeneca, The Medicines Company, OrbusNeich, Bayer, CSL Behring, Abbott Laboratories, Watermark Research Partners, Novartis Pharmaceuticals, Medtronic, AUM Cardiovascular, Inc., Beth Israel Deaconess Medical Center; executive committee – Janssen Pharmaceuticals, Osprey Medical Inc.; data safety monitoring board – Watermark Research Partners; consulting – Medscape, The Medicines Company, Boston Scientific, Merck & Company, Cardiovascular Systems, Inc. (CSI); Sanofi USA, LLC, Shanghai BraccoSine Pharmaceutical Corp.; AstraZeneca; equity – Claret Medical Inc., Elixir Medical Corporation. Dr Stone is a consultant for Matrizyme. The remaining authors have nothing to disclose. |
Vol 211
P. 68-76 - mai 2019 Retour au numéro
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