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Platelet reactivity and clinical outcomes following percutaneous coronary intervention in complex higher-risk

Michele M Viscusi1, Fabio Mangiacapra1, Edoardo Bressi1

  • 1Unit of Cardiovascular Science.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|September 21, 2021
PubMed

Insights

High platelet reactivity (HPR) combined with complex higher-risk and indicated patients (CHIP) features significantly increases major adverse clinical events (MACE) risk in stable coronary artery disease (CAD) patients post-PCI. This combination identifies high-risk individuals who may benefit from intensified antiplatelet therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Stable coronary artery disease (CAD) management involves percutaneous coronary intervention (PCI) and antiplatelet therapy.
  • High platelet reactivity (HPR) is a known risk factor, but its impact in specific patient subgroups requires further investigation.
  • Complex higher-risk and indicated patients (CHIP) represent a population with potentially distinct responses to treatment.

Purpose of the Study:

  • To assess HPR levels in stable CAD patients undergoing elective PCI.
  • To evaluate the impact of HPR on long-term clinical outcomes, specifically major adverse clinical events (MACE).
  • To determine the combined effect of CHIP features and HPR on MACE in this cohort.

Main Methods:

  • A cohort of 500 patients with stable CAD undergoing elective PCI and treated with aspirin and clopidogrel were enrolled.
  • Patients were stratified based on CHIP features and HPR status.
  • The primary endpoint was the incidence of MACE at 5-year follow-up, analyzed using Cox proportional hazard models.

Main Results:

  • HPR was more prevalent in the CHIP population (39.9%) compared to non-CHIP patients (29.8%).
  • Patients with both CHIP features and HPR exhibited the highest MACE rates (22.1%).
  • The combination of CHIP features and HPR independently predicted MACE (HR 2.57, P=0.006).

Conclusions:

  • In stable CAD patients undergoing elective PCI, the co-occurrence of CHIP features and HPR identifies a high-risk group for MACE.
  • This specific patient profile may warrant consideration for more potent antiplatelet strategies.
  • Understanding these combined risk factors can refine treatment decisions and improve long-term outcomes.
Abstract

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