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Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation: Results From the PTRG-DES Consortium

Authors
 Seung-Jun Lee  ;  Jung-Joon Cha  ;  Young-Hoon Jeong  ;  Sung-Jin Hong  ;  Chul-Min Ahn  ;  Jung-Sun Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang  ;  Hyung Joon Joo  ;  Kiyuk Chang  ;  Yongwhi Park  ;  Young Bin Song  ;  Sung Gyun Ahn  ;  Jung-Won Suh  ;  Sang Yup Lee  ;  Jung Rae Cho  ;  Ae-Young Her  ;  Hyo-Soo Kim  ;  Moo Hyun Kim  ;  Eun-Seok Shin  ;  Do-Sun Lim  ;  Byeong-Keuk Kim 
Citation
 JACC-CARDIOVASCULAR INTERVENTIONS, Vol.15(22) : 2253-2265, 2022-11 
Journal Title
JACC-CARDIOVASCULAR INTERVENTIONS
ISSN
 1936-8798 
Issue Date
2022-11
MeSH
Blood Platelets ; Drug-Eluting Stents* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention* / adverse effects ; Treatment Outcome
Keywords
drug-eluting stent(s) ; percutaneous coronary intervention ; platelet function tests ; stent thrombosis
Abstract
Background: The long-term prognostic implication of platelet reactivity after percutaneous coronary intervention (PCI) is not clearly known.

Objectives: The impacts of platelet reactivity from the PTRG-DES consortium were assessed.

Methods: The primary endpoint was the major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, myocardial infarction, stent thrombosis, or stroke. Key secondary endpoints were all-cause mortality, major bleeding, and net adverse clinical events (NACE), including MACCE and bleeding.

Results: Between 2003 and 2018, a total of 11,714 patients were enrolled and grouped into tertiles according to P2Y12 reaction units (PRUs): high PRUs (≥253), intermediate PRUs (188-252), and low PRUs (<188). The Kaplan-Meier (KM) estimates of the primary outcome were significantly different across the groups; the high-PRU group showed the highest MACCE rate at 5 years (12.9%, 11.1%, and 7.0% in high-, intermediate-, and low-PRU groups, respectively; P < 0.001), as well as at 1 year (P < 0.001). The high-PRU group had the greatest KM estimates of all-cause death (8.2%, 5.9%, and 3.7%, respectively; P < 0.001) at 5 years without significant differences of major bleeding, and resultant of a higher KM estimates of NACE (15.7%, 13.6%, and 9.7%, respectively; P < 0.001). A PRU ≥252, the best cutoff value, was strongly related to MACCE (HR: 1.39; 95% CI: 1.11-1.74; P = 0.003) and all-cause death at 5 years after PCI (HR: 1.42; 95% CI: 1.04-1.94; P = 0.026). The optimal cutoff value of aspirin reaction units predicting the MACCE occurrence was ≥414 and was significantly associated with 5-year MACCE occurrence or all-cause death (P < 0.001).

Conclusions: In this large-scale cohort, high PRU was significantly associated with occurrence of MACCE, all-death death, and NACE at 5 years, as well as 1 year after PCI. (PTRG-DES Consortium [PTRG]; NCT04734028).
Full Text
https://www.sciencedirect.com/science/article/pii/S193687982201706X
DOI
10.1016/j.jcin.2022.09.007
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Lee, Seung-Jun(이승준) ORCID logo https://orcid.org/0000-0002-9201-4818
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/192830
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