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A Nearly 50% Risk of MACCE Cutdown by Personalized Antiplatelet Therapy: The Subgroup Analysis of Hypertension in
Ting-Ting Wu1,2,3, Ying-Ying Zheng1,2, Zhi-Long Wang1
1Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.
Insights
Individualized antiplatelet therapy benefits patients undergoing percutaneous coronary intervention (PCI), reducing adverse events in both hypertensive and non-hypertensive individuals. This personalized approach improves outcomes compared to standard therapy.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Hypertension is a significant risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI).
- Individualized antiplatelet therapy is increasingly adopted for PCI patients.
- The study investigates the differential benefits of individualized therapy in PCI patients with and without hypertension.
Purpose of the Study:
- To evaluate the safety and efficacy of individualized antiplatelet therapy in PCI patients.
- To compare outcomes between patients with and without hypertension receiving individualized versus standard therapy.
Main Methods:
- A sub-analysis of the PATH-PCI study involving 2,237 chronic coronary syndrome patients.
- Patients were randomized to either personalized or standard antiplatelet therapy.
- Clinical outcomes were assessed at 180 days, with subgroup analysis for hypertensive and non-hypertensive patients.
Main Results:
- Individualized therapy significantly reduced major adverse cardiovascular and cerebrovascular events (MACCE) and major adverse cardiovascular events (MACE) in hypertensive PCI patients compared to standard therapy.
- Non-hypertensive patients also showed reduced NACE, MACCE, MACE, and recurrent myocardial infarction (Re-MI) with individualized therapy.
- Multivariable Cox analysis confirmed protective effects of individualized treatment against MACE, MACCE, and stent thrombosis (ST) in hypertensive patients, and against MACE, MACCE, and Re-MI in non-hypertensive patients.
Conclusions:
- Individualized antiplatelet therapy offers significant protective effects, reducing MACCE and MACE in all chronic coronary syndrome patients post-PCI without increasing bleeding risk.
- The therapy demonstrated a notable protective effect against stent thrombosis in hypertensive patients.
- A significant protective effect against recurrent myocardial infarction was observed in non-hypertensive patients receiving individualized therapy.
Background:
Individualized antiplatelet therapy has been gradually chosen by more and more (percutaneous coronary intervention) PCI patients. Hypertension, as an important risk factor for a variety of adverse outcomes after PCI, has been found in many studies. Therefore, we are interested in whether patients who undergo PCI have a different benefit from individualized antiplatelet therapy when they have hypertension.
Aims:
To evaluate the safety and efficacy of individualized treatment in PCI patients with or without hypertension.
Methods:
Two thousand two hundred and thirty-seven chronic coronary syndrome patients from PATH-PCI study were randomly assigned to receive either personalized antiplatelet therapy group or standard antiplatelet therapy group. Then sub-analysis were conducted to estimate the results of clinical outcomes after 180 days follow-up between hypertension or non-hypertension across the two treatment groups.
Results:
Compared with the standard treatment group, patients with hypertension who received individualized treatment had fewer adverse events. The MACCE incidences were (21 [3.3%] vs. 37 [5.8%], p = 0.038), MACE incidences was (14 [2.2%] vs. 28 [4.4%], p = 0.033), ST incidences was (2 [0.3%] vs. 10 [1.6%], p = 0.038), and TVR incidences was (1 [0.2%] vs. 8 [1.2%], p = 0.038). Within patients without hypertensive, after individualized therapy, there were also less NACE (25 [5.1%] vs. 39 [8.3%], p = 0.045), MACCE (14 [2.8%] vs. 33 [7.0%], p = 0.003), MACE (11 [2.2%] vs. 24 [5.1%], p = 0.017), and Re-MI incidences (7 [1.4%] vs. 17 [3.6%], p = 0.029) recorded. After multivariable Cox analyses, individualized treatment had a significant protective effect against MACE (HR = 0.48, 95% CI 0.25-0.92, p = 0.028), MACCE (HR = 0.55, 95% CI 0.32-0.94, p = 0.029), and ST (HR = 0.18, 95% CI 0.04-0.85, p = 0.030) in hypertensive patients. Besides, there were certain protective effects on reducing MACE (HR = 0.43, 95% CI 0.21-0.89, p = 0.023), MACCE (HR = 0.41, 95% CI 0.22-0.77, p = 0.005), and Re-MI (HR = 0.37, 95% CI 0.15-0.91, p = 0.029) incidences in non-hypertensive patients with personalized antiplatelet therapy.
Conclusion:
Individualized treatment can provided multiple protective effects, which significant decreasing the MACCE and MACE incidences in all CCS patients after PCI without increasing the risk of bleeding compared with standard therapy. Beside, a protective effect against stent thrombosis in hypertension and against Re-MI incidence in non-hypertension were obvious.
Trial Registration:
The details of the design were registered on http://www.chictr.org.cn (Identifier: ChiCTR-INR-16010077).
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