Prognostic implications of high platelet reactivity according to DAPT score after drug-eluting stent implantation: Insight from the PTRG-DES consortium

초록

Balancing ischemic and bleeding risk remains challenging in patients receiving dual antiplatelet therapy (DAPT) after percutaneous coronary intervention. We investigated the prognostic impact of high platelet reactivity (HPR) according to DAPT score strata after drug-eluting stent implantation. We analyzed 11,714 patients from the nationwide multicenter PTRG-DES registry who underwent PCI and platelet function testing using the VerifyNow assay. Patients were stratified according to DAPT score (≥2 vs <2). HPR was defined as PRU ≥ 252. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, myocardial infarction, stent thrombosis, or stroke. Secondary endpoints included individual ischemic outcomes and major bleeding. During a mean follow-up of 1,147 days, HPR was independently associated with higher risk of MACCE in both DAPT ≥ 2 (adjusted HR 1.34, 95% CI 1.04 to 1.75) and DAPT < 2 groups (adjusted HR 1.31, 95% CI 1.09 to 1.59). HPR was also associated with increased all-cause mortality irrespective of DAPT score. However, HPR was associated with major bleeding only in patients with DAPT ≥ 2, but not in those with DAPT < 2. A significant interaction between HPR and DAPT score strata was observed for major bleeding (p for interaction = 0.03), but not for ischemic outcomes. HPR identified residual ischemic risk beyond conventional DAPT score stratification, without increased bleeding risk among patients with DAPT score <2.

키워드