Relationship between platelet aggregation and stroke risk after percutaneous coronary intervention: a PENDULUM...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Pharmacology

Background:

• High on-treatment platelet reactivity (HPR) after percutaneous coronary intervention (PCI) with stenting is a potential risk factor for thrombotic events, including stroke.
• P2Y12 reaction unit (PRU) is a common assay for assessing platelet reactivity in patients treated with P2Y12 inhibitors.
• Understanding the relationship between PRU levels and stroke risk post-PCI is crucial for optimizing antiplatelet therapy.

Purpose of the Study:

• To investigate the association between on-treatment platelet reactivity, quantified by PRU values, and the risk of non-fatal stroke following PCI.
• To compare the incidence of ischemic and non-ischemic stroke across different categories of PRU levels (high, optimal, low).

Main Methods:

• A post hoc analysis of the PENDULUM registry involving patients aged ≥20 years who underwent PCI.
• Patients were stratified into high (HPR, PRU > 208), optimal (OPR, PRU > 85 to ≤ 208), and low (LPR, PRU ≤ 85) on-treatment platelet reactivity groups.
• Incidences of non-fatal ischemic and non-ischemic stroke were recorded up to 12 months post-PCI, with PRU measured at 12 and 48 hours.

Main Results:

• A total of 5906 patients had PRU data. The cumulative incidence of non-fatal ischemic stroke was 0.68% and non-ischemic stroke was 0.18%.
• Patients experiencing a non-fatal ischemic stroke had significantly higher post-PCI PRU values compared to those without stroke (P=0.037).
• A significant difference in the cumulative incidence of non-fatal stroke at 12 months was observed when stratifying by PRU ≤ 153 versus > 153 at 12-48 hours post-PCI (P=0.044).

Conclusions:

• Higher on-treatment platelet reactivity, indicated by elevated PRU values 12-48 hours post-PCI, is associated with an increased risk of ischemic stroke.
• The incidence of non-ischemic stroke was not found to be related to PRU values.
• These findings suggest that PRU monitoring may aid in identifying patients at higher risk of ischemic stroke after PCI, potentially guiding therapeutic adjustments.