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. 2018 May 24;18(1):103.
doi: 10.1186/s12872-018-0841-1.

Relationship between high platelet reactivity on clopidogrel and long-term clinical outcomes after drug-eluting stents implantation (PAINT-DES): a prospective, propensity score-matched cohort study

Xiao-Fei Gao  1 , Shu Lu  2 , Zhen Ge  3 , Guang-Feng Zuo  3 , Zhi-Mei Wang  1 , Feng Wang  1 , Xiang-Quan Kong  3 , Da-Yang Chai  2 , Shao-Liang Chen  1   3 , Jun-Jie Zhang  4   5
Affiliations

Relationship between high platelet reactivity on clopidogrel and long-term clinical outcomes after drug-eluting stents implantation (PAINT-DES): a prospective, propensity score-matched cohort study

Xiao-Fei Gao et al. BMC Cardiovasc Disord. .

Abstract

Background: The relationship between platelet reactivity and long-term clinical outcomes remains controversial. The present prospective study was designed to explore the association between high platelet reactivity (HPR) on clopidogrel and long-term clinical outcomes following implantation of drug eluting stents (DES).

Methods: A total of 1769 consecutive patients assessed by Aggrestar (PL-11) were enrolled at our center from February 2011 to December 2017. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCE), defined as definite or probable stent thrombosis, spontaneous myocardial infarction, all cause death, clinically driven target vessel revascularization (TVR), or ischemic stroke. Bleeding served as the safety endpoint. Propensity score matching (PSM) analysis was performed to adjust for baseline differences in the overall cohort.

Results: Finally, 409 patients (23.1%) were identified with HPR on clopidogrel. At a median follow-up of 4.1 years (interquartile range, 1.8 years), the occurrence of MACCE was significantly higher in HPR on clopidogrel group than normal platelet reactivity (NPR) on clopidogrel group (15.6% vs. 5.4%, p < 0.001). After PSM, 395 paired patients were matched, and the difference in MACCE between HPR (15.7%) versus NPR (9.4%) on clopidogrel groups remained significant (P < 0.001), mainly driven by increased all cause death (5.3% vs. 1.8%, p < 0.001), and clinically driven TVR (8.1% vs. 6.3%, p = 0.019) in the HPR group. The risk of bleeding between two groups was similar.

Conclusions: This prospective study confirms the relationship between HPR on clopidogrel and long-term adverse cardiovascular events after coronary stenting.

Keywords: Clopidogrel; Drug eluting stent; High platelet reactivity; Platelet function testing.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the institutional ethics committee of Nanjing First Hospital, and was carried out in accordance with the guidelines of the Declaration of Helsinki. Written informed consent was formally obtained from all participants.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Freedom from events in the propensity score-matched population. Freedom from major adverse cardiovascular and cerebrovascular events (MACCE) (a), definite/ probable stent thrombosis (ST) (b), all cause death (c), myocardial infarction (MI) (d), ischemic stroke (e), and clinically driven target vessel revascularization (TVR) (f) between high platelet reactivity (HPR) on clopidogrel and normal platelet reactivity (NPR) on clopidogrel in the propensity score-matched (PSM) population
Fig. 2
Fig. 2
Subgroup analysis. The increment in major adverse cardiovascular and cerebrovascular events (MACCE) with high platelet reactivity (HPR) on clopidogrel compared with normal platelet reactivity (NPR) on clopidogrel was consistent across pre-specified subgroups. BMI: body mass index; HF: heart failure; eGFR: estimated glomerular filtration rate; IVUS: intravascular ultrasound
See this image and copyright information in PMC

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