TCT-353 Underweight Status, Platelet Reactivity, and 2-Year Clinical Outcomes in Patients Undergoing PCI With DES: An ADAPT-DES Study Analysis.
The relationships between underweight status, platelet reactivity, and clinical outcomes after PCI with DES are not well understood.
ADAPT-DES was a prospective, multicenter study of 8582 pts treated with aspirin and clopidogrel in whom routine measurement of P2Y12 reaction units (PRU) by VerifyNow testing was performed following successful DES implantation. Pts were classified according to the following body mass index (BMI) groups: Underweight (BMI/m2), normal weight (20 kg/m2 ≤ BMI/m2), overweight (25 kg/m2 ≤ BMI/m2), and obese (BMI ≥30 kg/m2).
Underweight pts were more often female, smokers, had higher rates of peripheral arterial disease and renal insufficiency, and more frequently presented with an acute coronary syndrome than those with higher BMI. Underweight pts had significantly lower PRU and lower rates of high on-treatment platelet reactivity (HPR), while obese pts had higher PRU and higher rates of HPR. Underweight pts had higher 2-year rates of clinically relevant bleeding and mortality compared to normal weight patients (Figure). By multivariable analysis, underweight status was independently associated with higher rates of bleeding compared to normal weight status (HR 1.88 [1.02-3.47], p=0.04), with a trend toward greater all-cause mortality (HR 2.18 [0.99-4.79], p=0.053).
In this large, prospective, observational study of DES-treated patients, underweight status was associated with lower PRU on clopidogrel and significantly higher rates of bleeding at 2 years.
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Parikh, P. Kirtane, A. Weisz, G. Stuckey, T. Ozan, M. O., Witzenbichler, B. Rinaldi, M. Neumann, F. J., Metzger, D. C., Henry, T. Cox, D. A., Duffy, P. L., Brodie, B. Mazzaferri, E. Mehran, R. Stone, G. (2016). TCT-353 Underweight Status, Platelet Reactivity, and 2-Year Clinical Outcomes in Patients Undergoing PCI With DES: An ADAPT-DES Study Analysis. Journal Of The American College Of Cardiology (JACC), 68B145. doi:10.1016/j.jacc.2016.09.484
Cardiology | Medical Sciences | Medicine and Health Sciences
Department of Medicine, Cardiology Division, Department of Medicine Faculty