High on-treatment platelet reactivity was independently associated with an increased risk of cardiovascular events and mortality in patients with peripheral artery disease (OR 5.2).
Cohort (n=246)
No
Is high on-treatment platelet reactivity associated with increased cardiovascular events and mortality in patients with peripheral artery disease?
In patients with peripheral artery disease, high on-treatment platelet reactivity on aspirin or clopidogrel is strongly associated with an increased risk of cardiovascular events despite high medication adherence.
Odds Ratio: 5.2 (95% CI 1.5–18.5)
BACKGROUND: Patients with peripheral artery disease (PAD) are treated with preventive strategies to improve the cardiovascular risk. The incidence of cardiovascular events and mortality however remains high in PAD populations. We therefore aimed to better characterize PAD patients suffering from cardiovascular events and mortality in order to tailor preventive treatment. METHODS: Between 2018 and 2020, 246 PAD outpatients (17 newly diagnosed, 229 with known PAD) were prospectively enrolled in this observational cohort study. Patient data and blood samples were collected after inclusion, and the primary composite endpoint (myocardial infarction, elective coronary revascularization, ischemic stroke, acute limb ischemia, mortality) was evaluated after one year. Secondary outcomes included platelet reactivity, measured using the VerifyNow assay, and medication adherence, assessed using the Morisky Medication Adherence Scale-8 (MMAS-8). Logistic regression models were used to identify associations between characteristics and the occurrence of events. RESULTS: The cohort comprised 207 patients with claudication and 39 with chronic limb threatening ischemia. Twenty-six (10.6%) patients suffered from an event during follow-up. Prior myocardial infarction (OR 3.3 1.4-7.7), prior ischemic stroke (OR 4.5 1.8-10.9), higher levels of creatinine (OR 5.2 2.2-12.6), lower levels of high-density lipoprotein (OR 4.2 1.5-10.6) and lower haemoglobin levels (OR 3.1 1.3-7.1) were associated with events. Patients with events had more often high on-treatment platelet reactivity (HTPR) on aspirin (OR 5.9 1.4-25.1) or clopidogrel (OR 4.3 1-19.3). High adherence to medication was associated with the occurrence of events (OR 4.1 1-18). CONCLUSIONS: Patients suffering from cardiovascular events and mortality were characterized by prior cardiovascular events as compared to patients who did not experience any events. Antiplatelet therapy was not optimally protective despite high medication adherence, and HTPR was independently associated with the occurrence of events. More research is needed on alternative treatment strategies such as dual antiplatelet therapy or combinations with anticoagulant drugs. TRIAL REGISTRATION: The Medical Ethics Committee (METC) of the MUMC+ approved the study (NL63235.068.17) and the study was registered in the Netherlands Trial Register ( NTR7250 ).
Kremers et al. (Tue,) conducted a cohort in Peripheral artery disease (n=246). High on-treatment platelet reactivity (HTPR) vs. Normal platelet reactivity was evaluated on Composite of myocardial infarction, elective coronary revascularization, ischemic stroke, acute limb ischemia, and all-cause mortality (OR 5.2, 95% CI 1.5-18.5). High on-treatment platelet reactivity was independently associated with an increased risk of cardiovascular events and mortality in patients with peripheral artery disease (OR 5.2).
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