Author + information
- Bjorn Redforsa,b,
- Philippe Genereuxa,b,
- Ajay Kirtanea,b,
- Bernhard Witzenbichlera,b,
- Akiko Maeharaa,b,
- Giora Weisza,b,
- Thomas McAndrewa,b,
- Roxana Mehrana,b and
- Gregg Stonea,b
Background: Percutaneous coronary intervention (PCI) of in-stent restenotic (ISR) lesions is associated with a high risk of late adverse events. Although drug-eluting stents (DES) have had the best results in the few randomized trials that have been performed, the optimal treatment strategy for these lesions has not been established, and no studies have examined the impact of high platelet reactivity (HPR) on the occurrence of ischemic events after ISR PCI with DES. We sought to examine the rates of ischemic and bleeding events after ISR non-ISR PCI and their association with high platelet reactivity (HPR).
Methods: Subjects in the “all-comers,” prospective, multicenter Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents (ADAPT-DES) study were stratified according to whether they underwent PCI of an ISR or a non-ISR lesion. Two-year outcomes were compared between groups using Cox proportional hazards regression. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay. Target vessel failure (TVF) was defined as the composite of all-cause death, myocardial infarction, or ischemia-driven target vessel revascularization, and major adverse cardiac events (MACE) was defined as the composite of cardiac death, myocardial infarction, or stent thrombosis.
Results: Among 8,582 subjects, 840 (9.8%) underwent PCI for ISR. Compared to non-ISR PCI, ISR PCI was independently associated with a higher 2-year risk of TVF (adjusted hazard ratio [HR] 1.93; 95% confidence interval [CI] 1.67–2.24; p<0.001), MACE (adjusted HR 1.41; 95% CI 1.10–1.81; p=0.007), and stent thrombosis (adjusted HR 1.95; 95% CI 1.08–3.51; p=0.027), but not bleeding (adjusted HR 0.93; 95% CI 0.72–1.19; p=0.55). There was no statistical interaction between HPR and ISR vs. non-ISR PCI in regard to TVF or MACE (adjusted Pinteraction=0.81 and 0.28, respectively).
Conclusions: Treatment of ISR lesions with DES is associated with a considerably higher risk of 2-year adverse ischemic events than treatment of non-ISR lesions with DES, with HPR conferring a similar risk in ISR and non-ISR PCI. Outcomes of ISR treatment are suboptimal, representing a major unmet clinical need.
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: 1113-143
- 2017 American College of Cardiology Foundation