P2Y12-dependent high platelet reactivity independently predicted major adverse cardiac and cerebrovascular events at 12 months (HR 1.67) in patients with atrial fibrillation undergoing PCI.
Observational (n=147)
No
Does high platelet reactivity predict major adverse cardiac and cerebrovascular events in patients with atrial fibrillation undergoing percutaneous coronary intervention on dual or triple antithrombotic therapy?
In patients with atrial fibrillation undergoing PCI, high platelet reactivity on P2Y12 inhibitors is a strong independent predictor of thrombotic events at 3 and 12 months, suggesting potential utility for tailored antithrombotic therapy.
Effect estimate: HR 1.67 (95% CI 1.20 to 2.34)
p-value: p=0.003
Abstract High platelet reactivity (HPR) on clopidogrel is an established thrombotic risk factor after percutaneous coronary intervention (PCI). The introduction of more potent antiplatelet drugs has partially surpassed this issue. However, in the setting of concomitant atrial fibrillation (AF) and PCI clopidogrel is still the most adopted P2Y 12 inhibitor. In the present study all consecutive patients with history of AF discharged from our cardiology ward with dual (DAT) or triple (TAT) antithrombotic therapy after a PCI from April 2018 to March 2021 were enrolled in an observational registry. For all subjects, blood serum samples were collected and tested for platelet reactivity by arachidonic acid and ADP (VerifyNow system) and genotyping of the CYP2C19*2 loss-of-function polymorphism. We recorded at 3 and 12-months follow-up: (1) major adverse cardiac and cerebrovascular events (MACCE), (2) major hemorrhagic or clinically relevant non-major bleeding and (3) all-cause mortality. A total of 147 patients were included (91, 62% on TAT). In 93.4% of patients, clopidogrel was chosen as P2Y 12 inhibitor. P2Y 12 dependent HPR resulted an independent predictor of MACCE both at 3 and 12 months (HR 2.93, 95% C.I. 1.03 to 7.56, p = 0.027 and HR 1.67, 95% C.I. 1.20 to 2.34, p = 0.003, respectively). At 3-months follow-up the presence of CYP2C19*2 polymorphism was independently associated with MACCE (HR 5.21, 95% C.I. 1.03 to 26.28, p = 0.045). In conclusion, in a real-world unselected population on TAT or DAT, the entity of platelet inhibition on P2Y 12 inhibitor is a potent predictor of thrombotic risk, suggesting the clinical utility of this laboratory evaluation for a tailored antithrombotic therapy in this high-risk clinical scenario. Graphical abstract The present analysis was performed in patients with AF undergoing PCI on dual or triple antithrombotic therapy. At 1 year follow-up MACCE incidence was consistent, and it was not different in different antithrombotic pattern groups. P2Y 12 dependent HPR was a potent independent predictor of MACCE both at 3- and 12-months follow-up. In the first 3 months after stenting the carriage of CYP2C19*2 allele was similarly associated with MACCE. Abbreviation: DAT, dual antithrombotic therapy; HPR, high platelet reactivity; MACCE, major adverse cardiac and cerebrovascular events; PRU, P2Y 12 reactive unit; TAT, triple antithrombotic therapy. Created with BioRender.com.
Berteotti et al. (Sat,) conducted a observational in Atrial fibrillation and concomitant percutaneous coronary intervention (n=147). High platelet reactivity (HPR) on P2Y12 inhibitor vs. Normal platelet reactivity was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) at 12 months (HR 1.67, 95% CI 1.20 to 2.34, p=0.003). P2Y12-dependent high platelet reactivity independently predicted major adverse cardiac and cerebrovascular events at 12 months (HR 1.67) in patients with atrial fibrillation undergoing PCI.