Author + information
- Bjorn Redfors1,
- Philippe Généreux2,
- Bernhard Witzenbichler3,
- Ajay Jayant Kirtane4,
- Thomas McAndrew1,
- Bruce Brodie5,
- Michael Rinaldi6,
- Timothy Henry7,
- David Cox8,
- Ernest Mazzaferri Jr.9,
- Ori Ben-Yehuda10,
- Roxana Mehran11 and
- Gregg Stone12
- 1Cardiovascular Research Foundation, New York, New York, United States
- 2Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, United States
- 3Helios Amper-Klinikum, Dachau, Germany
- 4Columbia University / New York-Presbyterian Hospital, New York, New Jersey, United States
- 5LeBauer-Brodie Center for Cardiovascular Research and Education/Cone Health, Greensboro, North Carolina, United States
- 6Sanger Heart and Vascular Institute/Carolinas Medical Center, Charlotte, North Carolina, United States
- 7Cedars-Sinai Medical Center, Los Angeles, California, United States
- 8Lehigh Valley Health Network, Bethlehem, Pennsylvania, United States
- 9Ohio State University Medical Center, Columbus, Ohio, United States
- 10Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York, United States
- 11Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 12Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Small vessel diameter and residual high platelet reactivity (HPR) have both been associated with adverse events after PCI. We sought to determine whether a specific interaction exists between HPR and stent diameter in regard to outcomes after PCI.
We stratified pts in the prospective ADAPT-DES registry who underwent successful single-lesion PCI with DES according to whether or not they received only small diameter stents (diameter ≤2.5 mm). Pts receiving ≤2.5 mm stents were compared to pts receiving a stent with a diameter >2.5 mm using propensity score (PS) adjusted Cox proportional hazards regression. HPR was defined as P2Y12 reaction units >208, as assessed by the VerifyNow assay. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, MI, or stent thrombosis (ST).
Among 5608 pts who underwent single-lesion PCI, 1315 (23.4%) pts received ≤2.5 mm stents. Pts with ≤2.5 mm stents received fewer stents than patients with a >2.5 mm stent, but had significantly higher 2-year unadjusted rates of MACE (6.9% vs 5.2%, p=0.02) and MI (5.0% vs 3.6%, p=0.03), and had nominally higher rates of ST (1.5% vs 0.9%, p=0.065). Use of ≤2.5 mm vs >2.5 mm stents was associated with a significantly increased PS-adjusted risk of MI (adj hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.00-1.86, p=0.049) and ST (adj HR 1.99, 95% CI 1.07-3.69, p=0.03), with nominally higher MACE (adj HR 1.27, 95% CI 0.98-1.65, p=0.07). Presence vs. absence of HPR did not significantly moderate the risk associated with receiving ≤2.5 mm vs >2.5 mm stents in regard to MACE (adj HR 1.37, 95% CI 0.95-1.98 vs 1.18, 95% CI 0.81-1.71; pinteraction=0.56), MI (adj HR 1.45, 95% CI 0.94-2.24 vs 1.29, 95% CI 0.84-1.98; pinteraction=0.70), or ST (adj HR 1.28, 95% CI 0.56-2.94 vs 3.82, 95% CI 1.46-10.0; pinteraction=0.10).
PCI with small DES and HPR are both associated with a high risk of adverse events, including ST, although no specific interaction was noted between these risk conditions. Given higher absolute risk, potent antiplatelet therapies may be of particular benefit in pts with HPR after small diameter stent implantation.
CORONARY: Stents: Drug-Eluting