Platelet reactivity in patients with chronic kidney disease undergoing percutaneous coronary intervention

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Chronic kidney disease (CKD) is prevalent in patients undergoing percutaneous coronary intervention (PCI).
• Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is standard post-PCI, but high residual platelet reactivity (HRPR) can occur.
• The impact of CKD on HRPR and clinical outcomes after PCI requires further investigation.

Purpose of the Study:

• To evaluate HRPR in real-world patients with varying CKD stages post-PCI.
• To determine if HRPR is associated with adverse cardiovascular events over a 2-year follow-up.
• To assess the relationship between HRPR and bleeding events.

Main Methods:

• A cohort of 10,724 patients receiving DAPT post-PCI was analyzed.
• Modified thromboelastography (mTEG) was used to assess platelet reactivity in 6,745 patients.
• Kaplan-Meier and Cox proportional regression analyses were employed to evaluate clinical endpoints.

Main Results:

• The prevalence of HRPR for adenosine diphosphate (ADP) was significantly higher in patients with advanced CKD (stages 3-5) compared to those with early CKD (stages 1-2) (47.0% vs. 37.3%, p=0.002).
• HRPR for ADP was not associated with an increased incidence of major adverse cardiovascular and cerebrovascular events (MACCE) (HR 1.004, p=0.954).
• Conversely, patients with HRPR for ADP exhibited significantly lower bleeding event rates (HR 0.795, p=0.034).

Conclusions:

• Deterioration of renal function in CKD patients is associated with increased HRPR for ADP after PCI.
• HRPR for ADP does not appear to be a significant predictor of adverse cardiovascular events in CKD patients within a 2-year follow-up period.
• Higher residual platelet reactivity for ADP in PCI patients may be associated with a reduced risk of bleeding events.