Quantifying Ischemic Risk After Percutaneous Coronary Intervention Attributable to High Platelet Reactivity on Clopidogrel (From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents Study)

Autor: Michael J. Rinaldi, Björn Redfors, Gennaro Giustino, Akiko Maehara, Girma Minalu Ayele, Gregg W. Stone, Ariel Furer, Ajay J. Kirtane, David A. Cox, Philippe Généreux, Ernest L. Mazzaferri, Thomas Stuckey, Bernhard Witzenbichler, Giora Weisz, Sheng-Hsuan Lin, D. Christopher Metzger, Franz-Josef Neumann, Timothy D. Henry, Peter L. Duffy, Gary S. Mintz, Roxana Mehran, Ori Ben-Yehuda
Rok vydání: 2017
Předmět:
Male
medicine.medical_specialty
Ticlopidine
medicine.medical_treatment
Coronary Artery Disease
030204 cardiovascular system & hematology
Risk Assessment
Coronary artery disease
03 medical and health sciences
Percutaneous Coronary Intervention
0302 clinical medicine
Risk Factors
Germany
Internal medicine
medicine
Humans
Prospective Studies
Registries
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Israel
Aspirin
Dose-Response Relationship
Drug
business.industry
Incidence
Graft Occlusion
Vascular
Quebec
Percutaneous coronary intervention
Drug-Eluting Stents
Middle Aged
Platelet Activation
Prognosis
Clopidogrel
medicine.disease
United States
Survival Rate
Attributable risk
Cardiology
Drug Therapy
Combination
Female
Cardiology and Cardiovascular Medicine
business
Risk assessment
Platelet Aggregation Inhibitors
Mace
medicine.drug
Zdroj: The American Journal of Cardiology. 120:917-923
ISSN: 0002-9149
DOI: 10.1016/j.amjcard.2017.06.019
Popis: Patients at high risk of thrombotic events after percutaneous coronary intervention (PCI) may potentially benefit from intensified antiplatelet therapy. However, more potent antiplatelet therapy would be expected to only overcome risk that is mediated by high platelet reactivity (PR). We used mediation analysis to determine the contribution of residual PR to the 2-year risk of major adverse cardiac events (MACE; the composite of cardiac death, myocardial infarction, or stent thrombosis) associated with clinical risk factors after PCI with drug-eluting stents (DES) in 8,374 patients from the prospective, multicenter Assessment of Dual AntiPlatelet Therapy with Drug-Eluting Stents (ADAPT-DES) registry. Residual PR on clopidogrel, as measured by the VerifyNow P2Y12 point-of-care assay, was included as a continuous linear mediator variable in Cox proportional hazards regression. Among 7 factors independently associated with 2-year MACE, residual PR partly mediated the effect of diabetes (13.4% attributable risk), anemia (22.9% attributable risk), and acute coronary syndromes (7.3% attributable risk). A PR-mediated effect inversely affected the MACE risk associated with smoking (10.4% attributable risk). The increased ischemic risk of chronic kidney disease, multivessel disease, and previous myocardial infarction were not mediated by residual PR. In conclusion, high residual PR mediates little or none of the increased 2-year MACE risk associated with baseline risk factors in patients treated with clopidogrel after successful PCI with DES. Intensifying antiplatelet therapy is therefore unlikely to substantially mitigate the excess ischemic risk from these variables.
Databáze: OpenAIRE
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