Prognostic Implication of Platelet Reactivity According to Procedural Complexity After PCI: Subanalysis of PTRG-DES Consortium

Xuan Jin; Young-Hoon Jeong; Kwang Min Lee; Sung Cheol Yun; Byeong-Keuk Kim; Hyung Joon Joo; Kiyuk Chang; Yong Whi Park; Young Bin Song; Sung Gyun Ahn; Jung-Won Suh; Sang Yeub Lee; Jung Rae Cho; Ae-Young Her; Hyo-Soo Kim; Do-Sun Lim; Eun-Seok Shin; Moo Hyun Kim; PTRG-DES Consortium Investigators

doi:10.1016/j.jacasi.2023.10.011

Prognostic Implication of Platelet Reactivity According to Procedural Complexity After PCI: Subanalysis of PTRG-DES Consortium

JACC Asia. 2023 Dec 26;4(3):185-198. doi: 10.1016/j.jacasi.2023.10.011. eCollection 2024 Mar.

Authors

Xuan Jin^{1

2}, Young-Hoon Jeong³, Kwang Min Lee¹, Sung Cheol Yun⁴, Byeong-Keuk Kim⁵, Hyung Joon Joo⁶, Kiyuk Chang⁷, Yong Whi Park⁸, Young Bin Song⁹, Sung Gyun Ahn¹⁰, Jung-Won Suh¹¹, Sang Yeub Lee³, Jung Rae Cho¹², Ae-Young Her¹³, Hyo-Soo Kim¹⁴, Do-Sun Lim⁶, Eun-Seok Shin¹⁵, Moo Hyun Kim¹; PTRG-DES Consortium Investigators

Affiliations

¹ Department of Cardiology, Dong-A University Hospital, Busan, South Korea.
² Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, China.
³ CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
⁴ Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
⁵ Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁶ Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
⁷ Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, South Korea.
⁸ Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
⁹ Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹⁰ Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea.
¹¹ Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹² Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
¹³ Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea.
¹⁴ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
¹⁵ Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.

Abstract

Background: Complex percutaneous coronary intervention (C-PCI) and high platelet reactivity (HPR) have been proposed as representative risk factors for the high ischemic phenotype. Uncertainty remains regarding the relative prognostic importance of these factors.

Objectives: This study aimed to investigate the prognostic implication of HPR according to procedural complexity.

Methods: Patients treated with drug-eluting stent implantation (PTRG-PFT cohort; N = 11,714) were classified according to procedural complexity. HPR criteria were determined using VerifyNow (≥252 P2Y₁₂ reaction units). The major adverse cardiac and cerebrovascular events (MACCE) (the composite of all-cause death, myocardial infarction, definite stent thrombosis, or stroke) and major bleeding were assessed for up to 3 years.

Results: C-PCI was performed in 3,152 patients (26.9%). C-PCI significantly increased the risk of MACCE (HR_adjusted: 1.21; 95% CI: 1.01-1.44; P = 0.035), driven by a higher rate of all-cause death (HR_adjusted: 1.45; 95% CI: 1.15-1.83; P = 0.002), although it did not increase the risk of major bleeding. Irrespective of procedural complexity, the HPR phenotype was significantly associated with MACCE (P_interaction = 0.731) and all-cause mortality (P_interaction = 0.978), in which the prognostic implication appeared prominent within 1 year. The HPR phenotype did not show a significant interaction with any type of C-PCI. In addition, the number of complexity features per procedure did not proportionally increase the risk of MACCE.

Conclusions: C-PCI was significantly associated with 3-year risk of MACCE and all-cause death. The HPR phenotype appears to have a similar prognostic implication irrespective of the type and extent of procedural complexity. (Platelet Function and Genotype-Related Long-Term Prognosis in DES-Treated Patients [PTRG-DES]; NCT04734028).

Keywords: clinical outcomes; complex PCI; platelet reactivity.

Associated data

ClinicalTrials.gov/NCT04734028