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Association between High Platelet Reactivity Following Dual Antiplatelet Therapy and Ischemic Events in Japanese
Masakatsu Nishikawa1, Yoshihiro Takeda2, Naoei Isomura3
1Clinical Research Support Center, Mie University Hospital.
Insights
High on-treatment platelet reactivity (HTPR) after coronary stenting increases adverse ischemic outcomes in Japanese patients. This finding highlights HTPR as a potential prognostic indicator for patients on dual antiplatelet therapy.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- High on-treatment platelet reactivity (HTPR) during dual antiplatelet therapy (DAPT) is linked to adverse outcomes post-percutaneous coronary intervention (PCI).
- The prognostic value of HTPR in Japanese patients receiving DAPT remains uncertain.
Purpose of the Study:
- To investigate the association between platelet reactivity and 1-year clinical outcomes in Japanese patients undergoing coronary stenting.
- To evaluate the predictive value of HTPR for adverse events in this population.
Main Methods:
- A prospective, multicenter registry study (j-CHIPS) enrolled 1047 patients undergoing coronary stenting in Japan.
- Platelet reactivity was assessed using a VerifyNow assay in 854 patients receiving aspirin and clopidogrel.
- A cutoff value for HTPR was established to define high platelet reactivity.
Main Results:
- The incidence of major adverse cardiac and cerebrovascular events (MACCE) at 1 year was significantly higher in patients with HTPR (5.9%) compared to those without (1.5%) (p=0.008).
- HTPR demonstrated a modest ability to discriminate between patients experiencing MACCE (AUC=0.60, p=0.039).
- HTPR status did not predict major or minor bleeding events.
Conclusions:
- HTPR is significantly associated with adverse ischemic outcomes at 1 year following PCI in Japanese patients on maintenance DAPT.
- HTPR may serve as a valuable prognostic indicator for clinical outcomes in this high-risk patient group.
Aim:
Although high on-treatment platelet reactivity (HTPR) with dual antiplatelet therapy (DAPT) correlates with long-term adverse outcomes in patients undergoing percutaneous coronary intervention, the correlation in Japanese patients remains unclear. Therefore, we examined the relationship between platelet reactivity during DAPT with aspirin and clopidogrel and 1-year clinical outcomes following successful coronary stent implantation.
Methods:
A prospective, multicenter registry study (j-CHIPS) was conducted in patients undergoing coronary stenting and receiving aspirin and clopidogrel at 16 hospitals in Japan. A VerifyNow point-of-care assay was used to assess platelet reactivity, and a cutoff value to define HTPR was established.
Results:
Between February 2011 and May 2013, 1047 patients were prospectively enrolled, of which 854 patients with platelet function evaluation at 12-24 h after PCI were included in the final analysis. After 1 year of follow-up, the incidence of the primary endpoint (a composite of all-cause mortality, myocardial infarction, stent thrombosis, and ischemic stroke) was significantly higher in patients with HTPR than in those without (5.9% vs. 1.5%, p=0.008), and HTPR showed a modest ability to discriminate between patients who did and did not experience major adverse cardiac and cerebrovascular events (area under the curve, 0.60; 95% confidence interval, 0.511-0.688, p=0.039). HTPR status did not identify patients at risk for major or minor bleeding events.
Conclusion:
HTPR was significantly associated with adverse ischemic outcomes at 1 year after PCI in Japanese patients receiving maintenance DAPT, indicating its potential as a prognostic indicator of clinical outcomes in this high-risk patient population.
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