Key result
CHIP features combined with high platelet reactivity linked to ~157% higher 5-year MACE risk.
Why the study?
The impact of high platelet reactivity on long-term clinical outcomes in complex higher-risk patients with stable CAD undergoing elective PCI was not well defined.
Does the combination of CHIP features and high platelet reactivity predict MACE in patients with stable CAD undergoing elective PCI?
Cohort (n=500)
Does the combination of CHIP features and high platelet reactivity predict MACE in patients with stable CAD undergoing elective PCI?
Hazard Ratio: 2.57 (95% CI 1.3–5.05)
p-value: p=0.006
The combination of CHIP features and high platelet reactivity identifies a high-risk cohort for MACE at 5 years following elective PCI, suggesting a potential benefit from more potent antiplatelet therapy.
May refine post-PCI risk stratification in complex cases; leaves open whether reactivity-guided therapy improves outcomes.
AIMS: To investigate the levels of platelet reactivity and the impact of high platelet reactivity (HPR) on long-term clinical outcomes of complex higher-risk and indicated patients (CHIP) with stable coronary artery disease (CAD) treated with elective percutaneous coronary intervention (PCI). METHODS: We enrolled 500 patients undergoing elective PCI for stable CAD and treated with aspirin and clopidogrel. Patients were divided into four groups based on the presence of CHIP features and HPR. Primary endpoint was the occurrence of major adverse clinical events (MACE) at 5 years. RESULTS: The prevalence of HPR was significantly greater in the CHIP population rather than non-CHIP patients (39.9% vs 29.8%, P = 0.021). Patients with both CHIP features and HPR showed the highest estimates of MACE (22.1%, log-rank P = 0.047). At Cox proportional hazard analysis, the combination of CHIP features and HPR was an independent predictor of MACE (hazard ratio 2.57, 95% confidence interval 1.30-5.05, P = 0.006). CONCLUSION: Among patients with stable CAD undergoing elective PCI and treated with aspirin and clopidogrel, the combination of CHIP features and HPR identifies a cohort of patients with the highest risk of MACE at 5 years, who might benefit from more potent antiplatelet strategies.
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Viscusi et al. (2021) conducted a cohort in stable coronary artery disease (CAD) (n=500). Combination of CHIP features and high platelet reactivity (HPR) vs. Absence of combined CHIP features and HPR was evaluated on occurrence of major adverse clinical events (MACE) at 5 years (HR 2.57, 95% CI 1.30-5.05, p=0.006). The combination of complex higher-risk features and high platelet reactivity independently predicted major adverse clinical events at 5 years (HR 2.57; 95% CI 1.30-5.05; P=0.006).
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