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Impact of high on‐treatment platelet reactivity on outcomes following PCI in patients on hemodialysis: An ADAPT‐DES substudy
Author(s) -
Rubin Geoffrey A.,
Kirtane Ajay J.,
Chen Shmuel,
Redfors Björn,
Weisz Giora,
Baber Usman,
Zhang Yiran,
Stuckey Thomas D.,
Witzenbichler Bernhard,
Rinaldi Michael J.,
Neumann FranzJosef,
Metzger D. Christopher,
Henry Timothy D.,
Cox David A.,
Duffy Peter L.,
Brodie Bruce R.,
Mazzaferri Ernest L.,
Mehran Roxana,
Ali Ziad A.,
BenYehuda Ori,
Stone Gregg W.
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28577
Subject(s) - medicine , mace , percutaneous coronary intervention , conventional pci , clopidogrel , hemodialysis , myocardial infarction , cardiology , p2y12
OBJECTIVES We sought to compare clinical outcomes after percutaneous coronary intervention (PCI) in patients on versus not on hemodialysis (HD) and examine whether high on‐treatment platelet reactivity (HPR) further impacts outcomes among patients on HD. BACKGROUND Both chronic kidney disease (CKD) and HPR are predictors of major adverse cardiac events (MACE) after PCI. METHODS Two‐year outcomes of patients from the prospective, multicenter ADAPT‐DES study ( N = 8,582) were analyzed according to HD status at enrollment. All patients underwent platelet function testing with the VerifyNow assay; HPR on clopidogrel was defined as P2Y12 reaction units (PRU) >208. RESULTS Compared with non‐HD patients, patients on HD ( n = 85) had significantly higher baseline PRU (median 254 vs. 188, p = .001) and more frequently had HPR (61.7% vs. 42.5%, p < .001). HD was associated with increased 2‐year rates of MACE (death, myocardial infarction (MI) or definite stent thrombosis (ST); 23.4% vs. 10.7%, p < .001). HD was also strongly associated with 2‐year overall mortality, cardiac death, MI, target vessel revascularization, major bleeding, stroke and ST. Following adjustment for HPR and other covariates, HD was independently associated with overall mortality, MI, ST, and major bleeding at 2 years. The relationship between HD status and 2‐year MACE was consistent in patients with and without HPR ( P interaction = .78). CONCLUSIONS Nearly two‐thirds of patients on HD exhibited HPR on clopidogrel, and both HD and HPR were independently associated with 2‐year adverse outcomes after DES implantation. However, the deleterious impact of HD on clinical outcomes was present in both patients with and without HPR.