Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation in East Asian Patients: Results From the PTRG-DES Consortium

초록

Background:The long-term prognostic implication of platelet reactivity after percutaneous coronary intervention (PCI) is not clearly known in East Asian population. From PTRG-DES consortium of patients with drug-eluting stent (DES) implantation, the impacts of platelet reactivity on long-term clinical outcomes were assessed.Methods:The primary end point was the occurrence of major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, myocardial infarction, stent thrombosis, or stroke. Key secondary end points were all-cause mortality, major bleeding, and net adverse clinical events (NACE) including MACCE and major bleeding.Results:Between 2003 and 2018, a total of 11,714 patients were enrolled and grouped into tertile according to VerifyNow P2Y12 reaction units (PRU): High-PRU (≥253), Intermediate-PRU (188-252), and Low-PRU (<188). The occurrences of the primary outcome were significantly different across the groups; the High-PRU group showed the highest MACCE rate at 5 years (8.0%, 6.1%, and 4.0% in High-, Intermediate-, and Low-PRU; P < 0.001), as well as at 1 year (Figure A) (P < 0.001). The High-PRU group also had the greatest incidence of all-cause death (Figure B) (4.9%, 3.0%, and 2.1%; P < 0.001) at 5 years without significant differences of major bleeding (Figure C), and resultant of a significantly lower rate of NACE (Figure D) (10.2%, 8.0%, and 5.9%; P < 0.001). PRU ≥252, the best cutoff value of high platelet reactivity, was strongly related to MACCE (HR 1.39, 95% CI 1.11-1.74; P = 0.003), and all-cause death at 5 years after PCI (HR 1.42, 95% CI 1.04-1.94; P = 0.026).Conclusion:In this large-scale East Asian cohorts treated with DES, high PRU was significantly associated with occurrence of MACCE, all-death death, and NACE at 5 years.