Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation

초록

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),intermediatePRUs(188-252),andlowPRUs(<188).TheKaplan-Meier(KM)estimatesoftheprimaryoutcomeweresignificantlydifferentacrossthegroups;thehigh-PRUgroupshowedthehighestMACCErateat5years(12.9$252, the best cutoff value, was strongly related to MACCE (HR: 1.39; 95% CI: 1.11-1.74; P <1/4> 0.003) and all-cause death at 5 years after PCI (HR: 1.42; 95% CI: 1.04-1.94; P 1/4 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) (J Am Coll Cardiol Intv 2022;15:2253-2265) (c) 2022 by the American College of Cardiology Foundation.

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