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

• Published in: The American heart journal Vol. 211; pp. 68 - 76
• Main Authors: Finn, Matthew T., Redfors, Björn, Karmpaliotis, Dimitri, Kirtane, Ajay J., Green, Philip, McAndrew, Thomas, Liu, Mengdan, Cloney, Michael B., Witzenbichler, Bernhard, Weisz, Giora, Stuckey, Thomas D., Brodie, Bruce R., Rinaldi, Michael J., Neumann, Franz-Josef, Metzger, D. Christopher, Henry, Timothy D., Cox, David A., Duffy, Peter L., Mazzaferri, Ernest L., Mehran, Roxana, Stone, Gregg W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019; Elsevier Limited
• Subjects: Acute coronary syndromes; Age; Aged; Aspirin - therapeutic use; Bleeding; Blood platelets; Blood Platelets - physiology; Cardiac and Cardiovascular Systems; Cardiovascular disease; Continuity (mathematics); Coronary Occlusion - blood; Coronary Occlusion - surgery; Coronary vessels; Diabetes; Drug delivery; Drug dosages; Drug-Eluting Stents - adverse effects; Female; Fibrinolytic Agents - therapeutic use; Glycoproteins; Heart attacks; Heart failure; Humans; Implants; Intubation; Ischemia; Kardiologi; Male; Middle Aged; Myocardial infarction; Myocardial Ischemia - etiology; Occlusion; Patients; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Platelets; Postoperative Complications; Prospective Studies; Prosthesis Design; Risk; Stents; Surgical implants; Thrombosis
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2019.02.002

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. 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). 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). 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.