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Updated: Jul 1, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Prognostic Implication of Platelet Reactivity According to Procedural Complexity After PCI: Subanalysis of PTRG-DES
Xuan Jin1,2, Young-Hoon Jeong3, Kwang Min Lee1
1Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
Insights
Complex percutaneous coronary intervention (C-PCI) increases the risk of major adverse cardiac and cerebrovascular events (MACCE), but high platelet reactivity (HPR) poses a similar risk regardless of procedural complexity. HPR is a significant predictor of MACCE and death within one year.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Complex percutaneous coronary intervention (C-PCI) and high platelet reactivity (HPR) are recognized risk factors for ischemic events.
- The relative prognostic significance of C-PCI versus HPR in patients undergoing drug-eluting stent implantation remains unclear.
Purpose of the Study:
- To investigate the prognostic implications of high platelet reactivity (HPR) in the context of varying procedural complexity during percutaneous coronary intervention.
- To determine if procedural complexity modifies the impact of HPR on clinical outcomes.
Main Methods:
- A cohort of 11,714 patients receiving drug-eluting stents (PTRG-PFT cohort) was analyzed.
- Patients were stratified based on procedural complexity. High platelet reactivity (HPR) was defined as ≥252 P2Y12 reaction units.
- Major adverse cardiac and cerebrovascular events (MACCE) and major bleeding were assessed up to 3 years post-procedure.
Main Results:
- Complex PCI (C-PCI) was associated with an increased risk of MACCE (adjusted HR: 1.21), primarily driven by higher all-cause death rates (adjusted HR: 1.45).
- High platelet reactivity (HPR) was significantly associated with MACCE and all-cause mortality, irrespective of procedural complexity (P-interaction values > 0.7).
- The prognostic impact of HPR was most pronounced within the first year post-intervention, with no significant interaction observed between HPR and C-PCI types.
Conclusions:
- Complex PCI independently increases the 3-year risk of MACCE and all-cause death.
- High platelet reactivity (HPR) is a significant prognostic factor for MACCE and mortality, with its impact being consistent across different levels of procedural complexity.
- The findings suggest that HPR management is crucial regardless of PCI complexity in patients with drug-eluting stents.
Background:
Complex percutaneous coronary intervention (C-PCI) and high platelet reactivity (HPR) have been proposed as representative risk factors for the high ischemic phenotype. Uncertainty remains regarding the relative prognostic importance of these factors.
Objectives:
This study aimed to investigate the prognostic implication of HPR according to procedural complexity.
Methods:
Patients treated with drug-eluting stent implantation (PTRG-PFT cohort; N = 11,714) were classified according to procedural complexity. HPR criteria were determined using VerifyNow (≥252 P2Y12 reaction units). The major adverse cardiac and cerebrovascular events (MACCE) (the composite of all-cause death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding were assessed for up to 3 years.
Results:
C-PCI was performed in 3,152 patients (26.9%). C-PCI significantly increased the risk of MACCE (HRadjusted: 1.21; 95% CI: 1.01-1.44; P = 0.035), driven by a higher rate of all-cause death (HRadjusted: 1.45; 95% CI: 1.15-1.83; P = 0.002), although it did not increase the risk of major bleeding. Irrespective of procedural complexity, the HPR phenotype was significantly associated with MACCE (Pinteraction = 0.731) and all-cause mortality (Pinteraction = 0.978), in which the prognostic implication appeared prominent within 1 year. The HPR phenotype did not show a significant interaction with any type of C-PCI. In addition, the number of complexity features per procedure did not proportionally increase the risk of MACCE.
Conclusions:
C-PCI was significantly associated with 3-year risk of MACCE and all-cause death. The HPR phenotype appears to have a similar prognostic implication irrespective of the type and extent of procedural complexity. (Platelet Function and Genotype-Related Long-Term Prognosis in DES-Treated Patients [PTRG-DES]; NCT04734028).
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