Key result
Reduced left ventricular ejection fraction combined with high platelet reactivity significantly increased the risk of major adverse cardiac and cerebrovascular events (HR 3.14) in patients undergoing percutaneous coronary intervention.
Why the study?
Coronary artery disease patients undergoing PCI often have reduced LVEF, but the impact of LV dysfunction status combined with platelet reactivity on clinical outcomes has not been previously investigated.
Does reduced left ventricular ejection fraction and high platelet reactivity increase the risk of MACCEs and major bleeding in patients treated with drug-eluting stent implantation?
Cohort (n=9,319)
Yes
Does reduced left ventricular ejection fraction and high platelet reactivity increase the risk of MACCEs and major bleeding in patients treated with drug-eluting stent implantation?
Hazard Ratio: 2.17 (95% CI 1.85–2.55)
Absolute Event Rate: 13.2% vs 6%
p-value: p=<0.001
In patients undergoing drug-eluting stent implantation, reduced left ventricular ejection fraction and high platelet reactivity are independently and synergistically associated with an increased risk of major adverse cardiac and cerebrovascular events.
BACKGROUND: Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. METHODS: assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3-5. RESULTS: < 0.01, 95% CI 2.51-3.91). The frequency of major bleeding was not associated with the HPR in either group. CONCLUSION: LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04734028.
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Han et al. (2023) conducted a cohort in Coronary artery disease (n=9,319). Reduced left ventricular ejection fraction (<50%) and high platelet reactivity vs. Preserved left ventricular ejection fraction (≥50%) and low platelet reactivity was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) including all-cause death, myocardial infarction, definite stent thrombosis, or stroke (HR 2.17, 95% CI 1.85-2.55, p=<0.001). Reduced left ventricular ejection fraction combined with high platelet reactivity significantly increased the risk of major adverse cardiac and cerebrovascular events (HR 3.14) in patients undergoing percutaneous coronary intervention.
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