Impact of Point-of-Care Platelet Function Testing Among Patients With and Without Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents (from the ADAPT-DES Study)

Michael J. Rinaldi, Frank X. Gohs, Ajay J. Kirtane, Bruce R. Brodie, Thomas D. Stuckey, Björn Redfors, Thomas McAndrew, Bernhard Witzenbichler, Giora Weisz, Franz Josef Neumann, D. Christopher Metzger, Akiko Maehara, Philippe Genereux, Roxana Mehran, Gregg W. Stone

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

We sought to examine if the risk conferred by high on-treatment platelet reactivity (HPR) varies based upon clinical presentation. We examined the relation between HPR (P2Y12 reaction units >208) and adverse ischemic and bleeding events among patients with and without acute coronary syndromes (ACS) from ADAPT-DES; 51.7% of patients had ACS. After clopidogrel loading, ACS patients had higher P2Y12 reaction units and a greater prevalence of HPR based on VerifyNow P2Y12 assay. Of 92 definite or probable stent thrombosis (ST) events at 2 years, 65.2% occurred among patients with ACS. HPR was independently associated with ST in ACS patients (adjusted hazard ratio 2.29, 95% confidence interval 1.32 to 3.98) but not with clinically relevant bleeding. Although no statistical interactions between ACS status and these associations were observed, non-ACS patients exhibited an attenuated association between HPR and ST, and an inverse association between HPR and clinically relevant bleeding. HPR was similarly associated with myocardial infarction, but not with overall mortality in ACS and non-ACS patients. In conclusion, the majority of ST events in the 2 years after drug-eluting stent placement occurred in ACS patients; HPR was strongly associated with ST in these patients. These data support current recommendations for using more potent antiplatelet therapies in ACS patients.

Original languageEnglish (US)
Pages (from-to)549-557
Number of pages9
JournalAmerican Journal of Cardiology
Volume123
Issue number4
DOIs
StatePublished - Feb 15 2019
Externally publishedYes

Fingerprint

Point-of-Care Systems
Drug-Eluting Stents
Percutaneous Coronary Intervention
Acute Coronary Syndrome
Blood Platelets
Stents
Thrombosis
clopidogrel
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Rinaldi, Michael J. ; Gohs, Frank X. ; Kirtane, Ajay J. ; Brodie, Bruce R. ; Stuckey, Thomas D. ; Redfors, Björn ; McAndrew, Thomas ; Witzenbichler, Bernhard ; Weisz, Giora ; Neumann, Franz Josef ; Metzger, D. Christopher ; Maehara, Akiko ; Genereux, Philippe ; Mehran, Roxana ; Stone, Gregg W. / Impact of Point-of-Care Platelet Function Testing Among Patients With and Without Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents (from the ADAPT-DES Study). In: American Journal of Cardiology. 2019 ; Vol. 123, No. 4. pp. 549-557.
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abstract = "We sought to examine if the risk conferred by high on-treatment platelet reactivity (HPR) varies based upon clinical presentation. We examined the relation between HPR (P2Y12 reaction units >208) and adverse ischemic and bleeding events among patients with and without acute coronary syndromes (ACS) from ADAPT-DES; 51.7{\%} of patients had ACS. After clopidogrel loading, ACS patients had higher P2Y12 reaction units and a greater prevalence of HPR based on VerifyNow P2Y12 assay. Of 92 definite or probable stent thrombosis (ST) events at 2 years, 65.2{\%} occurred among patients with ACS. HPR was independently associated with ST in ACS patients (adjusted hazard ratio 2.29, 95{\%} confidence interval 1.32 to 3.98) but not with clinically relevant bleeding. Although no statistical interactions between ACS status and these associations were observed, non-ACS patients exhibited an attenuated association between HPR and ST, and an inverse association between HPR and clinically relevant bleeding. HPR was similarly associated with myocardial infarction, but not with overall mortality in ACS and non-ACS patients. In conclusion, the majority of ST events in the 2 years after drug-eluting stent placement occurred in ACS patients; HPR was strongly associated with ST in these patients. These data support current recommendations for using more potent antiplatelet therapies in ACS patients.",
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Rinaldi, MJ, Gohs, FX, Kirtane, AJ, Brodie, BR, Stuckey, TD, Redfors, B, McAndrew, T, Witzenbichler, B, Weisz, G, Neumann, FJ, Metzger, DC, Maehara, A, Genereux, P, Mehran, R & Stone, GW 2019, 'Impact of Point-of-Care Platelet Function Testing Among Patients With and Without Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents (from the ADAPT-DES Study)', American Journal of Cardiology, vol. 123, no. 4, pp. 549-557. https://doi.org/10.1016/j.amjcard.2018.11.026

Impact of Point-of-Care Platelet Function Testing Among Patients With and Without Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents (from the ADAPT-DES Study). / Rinaldi, Michael J.; Gohs, Frank X.; Kirtane, Ajay J.; Brodie, Bruce R.; Stuckey, Thomas D.; Redfors, Björn; McAndrew, Thomas; Witzenbichler, Bernhard; Weisz, Giora; Neumann, Franz Josef; Metzger, D. Christopher; Maehara, Akiko; Genereux, Philippe; Mehran, Roxana; Stone, Gregg W.

In: American Journal of Cardiology, Vol. 123, No. 4, 15.02.2019, p. 549-557.

Research output: Contribution to journalArticle

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AU - Rinaldi, Michael J.

AU - Gohs, Frank X.

AU - Kirtane, Ajay J.

AU - Brodie, Bruce R.

AU - Stuckey, Thomas D.

AU - Redfors, Björn

AU - McAndrew, Thomas

AU - Witzenbichler, Bernhard

AU - Weisz, Giora

AU - Neumann, Franz Josef

AU - Metzger, D. Christopher

AU - Maehara, Akiko

AU - Genereux, Philippe

AU - Mehran, Roxana

AU - Stone, Gregg W.

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N2 - We sought to examine if the risk conferred by high on-treatment platelet reactivity (HPR) varies based upon clinical presentation. We examined the relation between HPR (P2Y12 reaction units >208) and adverse ischemic and bleeding events among patients with and without acute coronary syndromes (ACS) from ADAPT-DES; 51.7% of patients had ACS. After clopidogrel loading, ACS patients had higher P2Y12 reaction units and a greater prevalence of HPR based on VerifyNow P2Y12 assay. Of 92 definite or probable stent thrombosis (ST) events at 2 years, 65.2% occurred among patients with ACS. HPR was independently associated with ST in ACS patients (adjusted hazard ratio 2.29, 95% confidence interval 1.32 to 3.98) but not with clinically relevant bleeding. Although no statistical interactions between ACS status and these associations were observed, non-ACS patients exhibited an attenuated association between HPR and ST, and an inverse association between HPR and clinically relevant bleeding. HPR was similarly associated with myocardial infarction, but not with overall mortality in ACS and non-ACS patients. In conclusion, the majority of ST events in the 2 years after drug-eluting stent placement occurred in ACS patients; HPR was strongly associated with ST in these patients. These data support current recommendations for using more potent antiplatelet therapies in ACS patients.

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