What is the clinical evidence from this study?

Study design: Cohort. Population: Stable angina (n=450). Intervention: High on-treatment platelet reactivity to ADP (PATI <4.8 μmol/L) vs. Low on-treatment platelet reactivity to ADP (PATI ≥4.8 μmol/L). Primary outcome: Composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis at 1 year (OR 3.82, 95% CI 1.85-7.87, p=<0.001).

January 1, 2012Circulation JournalOpen Access

Impact of Platelet Reactivity to Adenosine Diphosphate Before Implantation of Drug-Eluting Stents on Subsequent Adverse Cardiac Events in Patients With Stable Angina

Q: What are the key findings of this study?

High on-treatment platelet reactivity to ADP before drug-eluting stent implantation was associated with a significantly higher 1-year rate of adverse ischemic events compared to low reactivity (19.0% vs. 5.1%, OR 3.82).

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Key result

High on-treatment platelet reactivity to ADP before drug-eluting stent implantation was associated with a significantly higher 1-year rate of adverse ischemic events compared to low reactivity (19.0% vs. 5.1%, OR 3.82).

Why the study?

Does high on-treatment platelet reactivity to ADP predict adverse ischemic events in patients with stable angina undergoing drug-eluting stent implantation?

Population

450 consecutive Japanese patients with stable angina pectoris on dual anti-platelet therapy who underwent…

Comparison

High on-treatment platelet reactivity to… vs Low on-treatment platelet reactivity to ADP…

Design

Cohort

Follow-up

1 year

Authors

CMChikaaki MotodaHiroshima University HUHironori UedaHiroshima Prefectural Hospital YHYasuhiko HayashiKanazawa Medical University

Discussion

Member takes

Implication

May refine pre-DES risk stratification in stable angina; leaves open whether reactivity-guided therapy improves outcomes.

Study Design

Type

Cohort (n=450)

Multicenter

Structured PICO

Does high on-treatment platelet reactivity to ADP predict adverse ischemic events in patients with stable angina undergoing drug-eluting stent implantation?

Population

450 Japanese patients (mean age 71 years, 31.5% female) with stable angina undergoing drug-eluting stent implantation while on aspirin and ticlopidine, followed for 1 year.

Exposure

High on-treatment platelet reactivity to adenosine diphosphate (ADP), defined as a platelet aggregation threshold index (PATI) <4.8 µmol/L measured before stent implantation.

Comparator

Low on-treatment platelet reactivity to ADP, defined as a platelet aggregation threshold index (PATI) ≥4.8 µmol/L measured before stent implantation.

Outcome

Composite primary endpoint of cardiac death, myocardial infarction, target lesion revascularization (TLR; including surgical coronary artery bypass and repeat PCI of the original target lesion), and stent thrombosis within 1 year after stenting.composite

Main Result

Odds Ratio: 3.82 (95% CI 1.85–7.87)

Absolute Event Rate: 19% vs 5.1%

p-value: p=<0.001

High on-treatment platelet reactivity to ADP before drug-eluting stent implantation is significantly associated with an increased risk of adverse ischemic events, particularly target lesion revascularization, at 1 year.

Limitations

Single center study with a small sample size
High prevalence of target lesion revascularization compared to large-scale registries, possibly due to inclusion of complex lesions treated with rotational atherectomy
Use of ticlopidine instead of clopidogrel due to health insurance restrictions in Japan
PATI value varies depending on the timing of measurement after blood sampling
Ratio of patients with high on-treatment platelet reactivity might be higher in Japanese patients than in other populations
Single center and small sample size
Higher prevalence of TLR than large-scale registries, possibly due to inclusion of diffuse lesions with severe calcification treated with rotational atherectomy
Use of ticlopidine instead of clopidogrel due to Japanese health insurance restrictions at the time
PATI value shows a U-shaped variation depending on the timing of measurement after blood sampling

Cite This Study

Motoda et al. (2012) conducted a cohort in Stable angina (n=450). High on-treatment platelet reactivity to ADP (PATI <4.8 μmol/L) vs. Low on-treatment platelet reactivity to ADP (PATI ≥4.8 μmol/L) was evaluated on Composite of cardiac death, myocardial infarction, target lesion revascularization, and stent thrombosis at 1 year (OR 3.82, 95% CI 1.85-7.87, p=<0.001). High on-treatment platelet reactivity to ADP before drug-eluting stent implantation was associated with a significantly higher 1-year rate of adverse ischemic events compared to low reactivity (19.0% vs. 5.1%, OR 3.82).

synapsesocial.com/papers/6a82d32c1d8eddfbf50f7642 https://doi.org/10.1253/circj.cj-11-0435

Topics

Dual antiplatelet therapy Women and heart disease

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Impact of Platelet Reactivity to Adenosine Diphosphate Before Implantation of Drug-Eluting Stents on Subsequent Adverse Cardiac Events in Patients With Stable Angina

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Impact of Platelet Reactivity to Adenosine Diphosphate Before Implantation of Drug-Eluting Stents on Subsequent Adverse Cardiac Events in Patients With Stable Angina

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider