Prognostic Implication of Platelet Reactivity According to Procedural Complexity After PCI: Subanalysis of PTRG-DES Consortium

Overview

Journal JACC Asia

Date 2024 Mar 11

PMID 38463677

Authors

Xuan Jin

Young-Hoon Jeong

Kwang Min Lee

Sung Cheol Yun

Byeong-Keuk Kim

Hyung Joon Joo

Kiyuk Chang

Yong Whi Park

Young Bin Song

Sung Gyun Ahn

Jung-Won Suh

Sang Yeub Lee

Jung Rae Cho

Ae-Young Her

Hyo-Soo Kim

Do-Sun Lim

Eun-Seok Shin

Moo Hyun Kim

Affiliations

Soon will be listed here.

Abstract

Background: Complex percutaneous coronary intervention (C-PCI) and high platelet reactivity (HPR) have been proposed as representative risk factors for the high ischemic phenotype. Uncertainty remains regarding the relative prognostic importance of these factors.

Objectives: This study aimed to investigate the prognostic implication of HPR according to procedural complexity.

Methods: Patients treated with drug-eluting stent implantation (PTRG-PFT cohort; N = 11,714) were classified according to procedural complexity. HPR criteria were determined using VerifyNow (≥252 P2Y reaction units). The major adverse cardiac and cerebrovascular events (MACCE) (the composite of all-cause death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding were assessed for up to 3 years.

Results: C-PCI was performed in 3,152 patients (26.9%). C-PCI significantly increased the risk of MACCE (HR: 1.21; 95% CI: 1.01-1.44; = 0.035), driven by a higher rate of all-cause death (HR: 1.45; 95% CI: 1.15-1.83; = 0.002), although it did not increase the risk of major bleeding. Irrespective of procedural complexity, the HPR phenotype was significantly associated with MACCE ( = 0.731) and all-cause mortality ( = 0.978), in which the prognostic implication appeared prominent within 1 year. The HPR phenotype did not show a significant interaction with any type of C-PCI. In addition, the number of complexity features per procedure did not proportionally increase the risk of MACCE.

Conclusions: C-PCI was significantly associated with 3-year risk of MACCE and all-cause death. The HPR phenotype appears to have a similar prognostic implication irrespective of the type and extent of procedural complexity. (Platelet Function and Genotype-Related Long-Term Prognosis in DES-Treated Patients [PTRG-DES]; NCT04734028).

Citing Articles

Beyond Complexity: Addressing the Prognostic Landscape of High Platelet Reactivity.

Lee J, Kwon O JACC Asia. 2024; 4(3):199-200.

PMID: 38463678 PMC: 10920035. DOI: 10.1016/j.jacasi.2023.11.009.

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