Abstract
Objectives: The authors sought to investigate the association between P2Y12 reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. Background: The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. Methods: Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. Results: Among 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y12 receptor inhibition; 2-year rate of 0.51%) to the highest quintile of PRU (less P2Y12 receptor inhibition; 2-year rate of 1.34%; adjusted p = 0.04). PRU >208 was independently associated with higher risk of IS at 2 years (adjusted hazard ratio 1.81; 95% confidence interval 1.08 to 3.04; p = 0.03). The association between higher PRU and risk for IS was also consistent in patients with versus without high CHA2DS2-VASc score (pinteraction = 0.30) and in those on or off oral anticoagulation at discharge (pinteraction = 0.99). Occurrence of IS was strongly associated with increased risk of all-cause mortality at 2 years (adjusted HR: 4.16; 95% CI: 1.95 to 8.87; p < 0.0001). Conclusions: Higher PRU was associated with increased risk of IS after coronary DES implantation. Ensuring adequate platelet P2Y12 receptor inhibition may reduce the risk of IS in this patient population. (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents [ADAPT-DES]; NCT00638794)
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1277-1286 |
| Number of pages | 10 |
| Journal | JACC: Cardiovascular Interventions |
| Volume | 11 |
| Issue number | 13 |
| DOIs | |
| State | Published - Jul 9 2018 |
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All Science Journal Classification (ASJC) codes
- Cardiology and Cardiovascular Medicine
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Platelet Reactivity and Risk of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation : From the ADAPT-DES Study. / Giustino, Gennaro; Redfors, Björn; Kirtane, Ajay J.; Mehran, Roxana; Dangas, George D.; Witzenbichler, Bernhard; Neumann, Franz Josef; Weisz, Giora; Généreux, Philippe; Maehara, Akiko; McAndrew, Thomas; Farhan, Serdar; Rinaldi, Michael J.; Metzger, D. Christopher; Henry, Timothy D.; Cox, David A.; Duffy, Peter L.; Mazzaferri, Ernest L.; Brodie, Bruce R.; Stuckey, Thomas D.; Gurbel, Paul; Ben-Yehuda, Ori; Stone, Gregg W.
In: JACC: Cardiovascular Interventions, Vol. 11, No. 13, 09.07.2018, p. 1277-1286.Research output: Contribution to journal › Article
TY - JOUR
T1 - Platelet Reactivity and Risk of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation
T2 - From the ADAPT-DES Study
AU - Giustino, Gennaro
AU - Redfors, Björn
AU - Kirtane, Ajay J.
AU - Mehran, Roxana
AU - Dangas, George D.
AU - Witzenbichler, Bernhard
AU - Neumann, Franz Josef
AU - Weisz, Giora
AU - Généreux, Philippe
AU - Maehara, Akiko
AU - McAndrew, Thomas
AU - Farhan, Serdar
AU - Rinaldi, Michael J.
AU - Metzger, D. Christopher
AU - Henry, Timothy D.
AU - Cox, David A.
AU - Duffy, Peter L.
AU - Mazzaferri, Ernest L.
AU - Brodie, Bruce R.
AU - Stuckey, Thomas D.
AU - Gurbel, Paul
AU - Ben-Yehuda, Ori
AU - Stone, Gregg W.
PY - 2018/7/9
Y1 - 2018/7/9
N2 - Objectives: The authors sought to investigate the association between P2Y12 reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. Background: The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. Methods: Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. Results: Among 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y12 receptor inhibition; 2-year rate of 0.51%) to the highest quintile of PRU (less P2Y12 receptor inhibition; 2-year rate of 1.34%; adjusted p = 0.04). PRU >208 was independently associated with higher risk of IS at 2 years (adjusted hazard ratio 1.81; 95% confidence interval 1.08 to 3.04; p = 0.03). The association between higher PRU and risk for IS was also consistent in patients with versus without high CHA2DS2-VASc score (pinteraction = 0.30) and in those on or off oral anticoagulation at discharge (pinteraction = 0.99). Occurrence of IS was strongly associated with increased risk of all-cause mortality at 2 years (adjusted HR: 4.16; 95% CI: 1.95 to 8.87; p < 0.0001). Conclusions: Higher PRU was associated with increased risk of IS after coronary DES implantation. Ensuring adequate platelet P2Y12 receptor inhibition may reduce the risk of IS in this patient population. (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents [ADAPT-DES]; NCT00638794)
AB - Objectives: The authors sought to investigate the association between P2Y12 reaction units (PRU) and the risk of ischemic stroke (IS) after successful coronary drug-eluting stents (DES) implantation. Background: The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear. Methods: Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation. Results: Among 8,582 patients enrolled, 68 (0.8%) had an IS during 2-year follow-up. Across the spectrum of PRU, rates of IS were progressively greater as patients transitioned from the lowest quintile of PRU (more P2Y12 receptor inhibition; 2-year rate of 0.51%) to the highest quintile of PRU (less P2Y12 receptor inhibition; 2-year rate of 1.34%; adjusted p = 0.04). PRU >208 was independently associated with higher risk of IS at 2 years (adjusted hazard ratio 1.81; 95% confidence interval 1.08 to 3.04; p = 0.03). The association between higher PRU and risk for IS was also consistent in patients with versus without high CHA2DS2-VASc score (pinteraction = 0.30) and in those on or off oral anticoagulation at discharge (pinteraction = 0.99). Occurrence of IS was strongly associated with increased risk of all-cause mortality at 2 years (adjusted HR: 4.16; 95% CI: 1.95 to 8.87; p < 0.0001). Conclusions: Higher PRU was associated with increased risk of IS after coronary DES implantation. Ensuring adequate platelet P2Y12 receptor inhibition may reduce the risk of IS in this patient population. (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents [ADAPT-DES]; NCT00638794)
UR - http://www.scopus.com/inward/record.url?scp=85048149621&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85048149621&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2018.01.263
DO - 10.1016/j.jcin.2018.01.263
M3 - Article
C2 - 29908967
AN - SCOPUS:85048149621
VL - 11
SP - 1277
EP - 1286
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 13
ER -