Author + information
- Jaya Chandrasekhar,
- Roxana Mehran,
- George Dangas,
- Thomas McAndrew,
- Yiran Zhang,
- Philippe Genereux,
- Ajay Kirtane and
- Gregg Stone
Background: Whether thrombotic and bleeding risks have a differential impact on mortality by platelet reactivity status is unknown.
Methods: The prospective, multicenter ADAPT-DES study was an all-comer PCI registry (n=8454) assessing platelet reactivity on clopiodgrel after successful DES. High platelet reactivity (HPR) was defined as VerifyNow platelet reactivity units >208. We calculated thrombotic (TR) and bleeding risk (BR) using validated scores for stent thrombosis and bleeding respectively (Figure 1). The primary endpoint was 2-year mortality by both scores in HPR and non-HPR pts. We further analyzed whether BR was an independent predictor of 2-year mortality.
Results: In the overall population, the prevalence of HPR, high BR and high TR were 42.7%, 20.7% and 6.8% respectively. Pts with HPR were more likely to be high BR (26.1% vs. 16.8%, p=0.0001) and high TR (7.8% vs. 6.1%, p=0.002) compared to non-HPR pts (Figure). In both HPR and non-HPR subgroups, the unadjusted 2-year mortality was greatest in high BR patients regardless of TR (Figure). In a multivariable model, BR was an independent predictor of 2-year mortality in both HPR (HR 2.81, 95% CI 2.05, 3.85) and non-HPR (HR 4.41, 95% CI 3.11, 6.25) groups.
Conclusions: In the ADAPT-DES study, patients with high predicted BR had increased rates of 2-year mortality, irrespective of HPR status. BR should be assessed to comprehensively characterize patient risk after PCI.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-132
- 2017 American College of Cardiology Foundation