Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec 26;4(3):185-198.
doi: 10.1016/j.jacasi.2023.10.011. eCollection 2024 Mar.

Prognostic Implication of Platelet Reactivity According to Procedural Complexity After PCI: Subanalysis of PTRG-DES Consortium

Xuan Jin  1   2 , Young-Hoon Jeong  3 , Kwang Min Lee  1 , Sung Cheol Yun  4 , Byeong-Keuk Kim  5 , Hyung Joon Joo  6 , Kiyuk Chang  7 , Yong Whi Park  8 , Young Bin Song  9 , Sung Gyun Ahn  10 , Jung-Won Suh  11 , Sang Yeub Lee  3 , Jung Rae Cho  12 , Ae-Young Her  13 , Hyo-Soo Kim  14 , Do-Sun Lim  6 , Eun-Seok Shin  15 , Moo Hyun Kim  1 ; PTRG-DES Consortium Investigators
Affiliations

Prognostic Implication of Platelet Reactivity According to Procedural Complexity After PCI: Subanalysis of PTRG-DES Consortium

Xuan Jin et al. JACC Asia. .

Abstract

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).

Keywords: clinical outcomes; complex PCI; platelet reactivity.

PubMed Disclaimer

Conflict of interest statement

The study was designed by the principal investigator and executive committee, and was sponsored by the Korean Society of Interventional Cardiology. Dr Jeong has received honoraria for lectures for AstraZeneca, Daiichi-Sankyo, Sanofi, Hanmi Pharmaceuticals, and Yuhan Corporation; and research grants or support from Yuhan Corporation and U&I Corporation. Dr Joo has received honoraria for lectures for AstraZeneca, Hanmi, Samjin, Dong-A, HK inno, N Pharmaceuticals, and DIO Medical Ltd. Dr Song has received honoraria for lectures for AstraZeneca, Daiichi-Sankyo, Sanofi, Bayer Korea, and Samjin Pharmaceutical. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study Flow Diagram A total of 13,160 participants from the PTRG-DES (Platelet Function and Genotype-Related Long-Term Prognosis in DES-Treated Patients) consortium treated with drug-eluting stents were enrolled between July 2003 and August 2018. Patients in the platelet function test cohort (PFT) (n = 11,714) were classified according to procedural complexity and platelet reactivity. High platelet reactivity (HPR) criteria were determined using VerifyNow (≥252 P2Y12 reaction units). The primary endpoint was the occurrence of major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, nonfatal myocardial infarction (MI), definite stent thrombosis (ST), or nonfatal stroke during the 3-year follow-up period. PCI = percutaneous coronary intervention.
Central Illustration
Central Illustration
Clinical Outcomes of Procedural Complexity in Patients Undergoing Percutaneous Coronary Intervention (A) Proportion of complex percutaneous coronary intervention (PCI), high platelet reactivity (HPR), and subtype of complex PCI. (B) The cumulative incidence of major adverse cardiac and cerebrovascular events (MACCE) according to complex PCI. (C) Prognostic implication of HPR according to presence of complex PCI.
Figure 2
Figure 2
Kaplan-Meier Curves for MACCE and Death According to Complex PCI Kaplan-Meier estimates were conducted between the 2 groups for (A) MACCE and (B) death according to the complexity of PCI. Bonferroni’s correction was applied for multiple comparisons between the 2 groups. Abbreviations as in Figure 1.
Figure 3
Figure 3
Incidence Rate of MACCE According to Quartile Distribution of PRU Incidence rate of MACCE between complex PCI (A) and noncomplex PCI (B) according to quartile distribution of P2Y12 reaction unit (PRU). Bonferroni’s correction was applied for multiple comparisons between the 2 groups. Abbreviations as in Figure 1.
Figure 4
Figure 4
Kaplan-Meier Curves for MACCE and Death by PCI and HPR Kaplan-Meier estimates were conducted among the 4 groups for (A) MACCE and (B) death according to complex PCI and HPR. Bonferroni’s correction was applied for multiple comparisons among the 4 groups. Abbreviations as in Figure 1.
Figure 5
Figure 5
Impacts of HPR on MACCE and Major Bleeding (A and C) subtype of complex PCI and (B and D) the extent of procedural complexity. Abbreviations as in Figures 1 and 2.
Figure 5
Figure 5
Impacts of HPR on MACCE and Major Bleeding (A and C) subtype of complex PCI and (B and D) the extent of procedural complexity. Abbreviations as in Figures 1 and 2.
See this image and copyright information in PMC

References

    1. Capodanno D., Alfonso F., Levine G.N., et al. ACC/AHA versus ESC guidelines on dual antiplatelet therapy: JACC guideline comparison. J Am Coll Cardiol. 2018;72:2915–2931. - PubMed
    1. Colombo A., Chieffo A., Frasheri A., et al. Second-generation drug-eluting stent implantation followed by 6- versus 12-month dual antiplatelet therapy: the SECURITY randomized clinical trial. J Am Coll Cardiol. 2014;64:2086–2097. - PubMed
    1. Giustino G., Chieffo A., Palmerini T., et al. Efficacy and safety of dual antiplatelet therapy after complex PCI. J Am Coll Cardiol. 2016;68:1851–1864. - PubMed
    1. Mehran R., Giustino G., Baber U. DAPT duration after DES: what is the "mandatory" duration? J Am Coll Cardiol. 2015;65:1103–1106. - PubMed
    1. Neumann F.J., Sousa-Uva M., Ahlsson A., et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J. 2019;40:87–165. - PubMed

Associated data

LinkOut - more resources