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Background: Patients undergoing complex percutaneous coronary intervention (CPCI) have a higher risk of ischemic events, which is probably due to excessive activation of platelet. The role of serial platelet function testing (PFT) among those patients is still unclear. We conducted this study to determine the utility of serial PFT for predicting long-term prognosis among patients receiving CPCI and optimized dual antiplatelet therapy (DAPT) strategy in this population.
Methods: We screened 2141 patients undergoing successful PCI and treated with aspirin and clopidogrel. CPCI was defined as a procedure targeted to at least one of the following: left main disease; bifurcation lesion; ostial lesion; chronic total occlusion and small vessel stenting (<2.5 mm). Adenosine diphosphate(ADP) -induced platelet aggregation was measured by light transmission aggregometry on the 1st, 6th and 12th month after PCI and the mean value was calculated. The population was categorized according to the mean ADP degree (cut-off value was 40%) and presence/absence of CPCI. The primary endpoint was major adverse cardiovascular and cerebral event (MACCE) defined as a composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, unexpected repeat revascularization and stroke.
Results: Finally, one thousand two hundred and forty-five patients were enrolled and divided into four groups: Group A (CPCI & ADP≥40%), Group B (CPCI & ADP<40%), Group C (non-CPCI & ADP≥40%) and Group D (non-CPCI & ADP<40%). The median follow-up was 29.9 months (IQR 21.9 to 34.1). The Cox multivariate analysis suggested that Group A was an independent risk factor of MACCE (HR 2.70, 95%CI 1.25–5.81; P<0.001). When Group A was set as the reference category in multivariate analysis, Group B, C and D were all associated with a lower rate of MACCE. Compared with standard DAPT (12 months), prolonged DAPT (>12 months) in Group A could not reduce the incidence of MACCE (log-rank test, P=0.57).
Conclusions: Patients with high mean ADP degree undergoing CPCI were associated with an increased incidence of MACCE. Serial PFT could only predict the long-term prognosis of patients underwent CPCI.
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: 1113-146
- 2017 American College of Cardiology Foundation