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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with
Jieyun You1, Hongda Li1, Wei Guo1
1Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Insights
Switching from clopidogrel to ticagrelor in ST-segment elevation myocardial infarction patients with high platelet reactivity significantly reduces major adverse cardio-cerebral events. This intensified antiplatelet strategy improves outcomes without increasing bleeding risk.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor is standard for acute coronary syndrome and percutaneous coronary intervention (PCI).
- Routine platelet function testing (PFT) in DAPT post-PCI is controversial.
- Evidence for PFT-guided therapy in ST-segment elevation myocardial infarction (STEMI) primary PCI is limited.
Purpose of the Study:
- To evaluate the efficacy of PFT-guided antiplatelet therapy in STEMI patients undergoing primary PCI.
- To compare clinical outcomes of switching P2Y12 inhibitors versus continuing clopidogrel in patients with high platelet reactivity (HPR).
Main Methods:
- 1,353 STEMI patients undergoing primary PCI were analyzed.
- Platelet function testing (PFT) performed 72 hours post-PCI using a vasodilator-stimulated phosphoprotein (VASP) assay.
- Patients with HPR were randomized to switch to ticagrelor or continue clopidogrel; outcomes compared to non-HPR patients.
Main Results:
- The primary endpoint of major adverse cardio-cerebral events (MACCE) was significantly higher in the HPR nonswitch group (19.49%) compared to non-HPR (10.20%) and HPR switch (8.57%) groups at 1 year.
- Higher mortality in the HPR nonswitch group (14.87%) drove the increased MACCE rate.
- Major bleeding events were similar across all groups.
Conclusions:
- In STEMI patients with HPR identified by VASP PFT, switching from clopidogrel to ticagrelor significantly improves 1-year clinical outcomes.
- This intensified antiplatelet strategy does not increase the risk of bleeding.
Background:
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor has become the standard of care to reduce thrombotic events in patients with acute coronary syndrome or after percutaneous coronary intervention (PCI). The role of routine platelet function testing (PFT) in patients treated with DAPT after PCI remains controversial and evidence of PFT-guided antiplatelet therapy for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI is limited.
Methods:
We analyzed 1,353 consecutive STEMI patients undergoing primary PCI. PFT was performed 72 hr postprocedure using a vasodilator-stimulated phosphoprotein assay. The primary endpoint of major adverse cardio-cerebral events (MACCEs) was defined as a composite of all-cause death, cardiac death, nonfatal myocardial infarction, target vessel revascularization, and ischemic stroke. Patients with high platelet reactivity (HPR) were randomized to receive an intensified antiplatelet strategy by switching from clopidogrel to ticagrelor (HPR switch group) or to continue on clopidogrel (HPR nonswitch group). One-year clinical outcomes were compared among the groups.
Results:
The baseline clinical characteristics were comparable across all groups (all p > .05). At the 1-year clinical follow-up, the primary endpoint of MACCE was significantly higher in the HPR nonswitch group than in the non-HPR and HPR switch groups (19.49% vs. 10.20% or 8.57%, p < .05), which was mainly caused by higher mortality (14.87% vs. 4.51% or 5.71%, p < .05). Major bleeding events were comparable across the groups.
Conclusions:
In STEMI patients with HPR, identified by vasodilator stimulated phosphoprotein (VASP)-determined PFT, switching clopidogrel to ticagrelor could significantly improve 1-year clinical outcomes without increasing the risk of bleeding.
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