The Clinical Impact of Dual Antiplatelet Therapy Score Combined With P2Y12 Reactivity Unit on East Asian Patients Who Received Drug-Eluting Stent Implantation: PTRG-DES Consortium

초록

Background:Our aim is to assess the clinical implication of a P2Y12 reactivity unit combined with dual antiplatelet therapy (DAPT) score in East Asian patients who received percutaneous coronary intervention (PCI) along with DAPT therapy over 1 year.Methods:Among the 13,160 patients from the nationwide multicenter PTRG-DES registry, patients who had received PCI along with DAPT therapy over 1 year without any clinical events from July of 2003 to August of 2018 were enrolled. The patients were divided into HPR(+) and HPR(–) groups by a P2Y12 reactivity unit cutoff value of 208 U. These patients were classified according to their DAPT score (DAPT score ≥2 and DAPT score <2). The primary endpoint was all-cause mortality from 12 months to 30 months after index PCI.Results:The HPR(+) group showed higher all-cause mortality compared with the HPR(–) group by multivariate Cox regression analysis (1.8% vs 0.8%; HR: 1.629; 95% CI: 1.046-2.538; P = 0.031). Among the patients with a DAPT score <2, the HPR(+) group consistently showed significantly higher all-cause mortality than the HPR(–) group (1.9% vs 0.8%, HR: 1.937; 95% CI: 1.108-3.387; P = 0.02). However, it was not statistically significant in patients with a DAPT score ≥2 (1.7% vs 0.9%; HR: 1.533; 95% CI: 1.108-3.387; P = 0.25) after multivariate Cox regression analysis.Conclusion:In patients who were event free with DAPT therapy for 12 months after index PCI, HPR(+) was associated with higher all-cause mortality from 12 months to 30 months, especially in patients with a low DAPT score. Combination of HPR and DAPT score can stratify patients who are likely to have an increased risk of all-cause mortality.