Small vessel diameter and residual high platelet reactivity (HPR) have both been associated with adverse events after PCI. We sought to determine whether a specific interaction exists between HPR and stent diameter in regard to outcomes after PCI.
We stratified pts in the prospective ADAPT-DES registry who underwent successful single-lesion PCI with DES according to whether or not they received only small diameter stents (diameter ≤2.5 mm). Pts receiving ≤2.5 mm stents were compared to pts receiving a stent with a diameter >2.5 mm using propensity score (PS) adjusted Cox proportional hazards regression. HPR was defined as P2Y12 reaction units >208, as assessed by the VerifyNow assay. Major adverse cardiac events (MACE) were defined as the composite of cardiac death, MI, or stent thrombosis (ST).
Among 5608 pts who underwent single-lesion PCI, 1315 (23.4%) pts received ≤2.5 mm stents. Pts with ≤2.5 mm stents received fewer stents than patients with a >2.5 mm stent, but had significantly higher 2-year unadjusted rates of MACE (6.9% vs 5.2%, p=0.02) and MI (5.0% vs 3.6%, p=0.03), and had nominally higher rates of ST (1.5% vs 0.9%, p=0.065). Use of ≤2.5 mm vs >2.5 mm stents was associated with a significantly increased PS-adjusted risk of MI (adj hazard ratio [HR] 1.36, 95% confidence interval [CI] 1.00-1.86, p=0.049) and ST (adj HR 1.99, 95% CI 1.07-3.69, p=0.03), with nominally higher MACE (adj HR 1.27, 95% CI 0.98-1.65, p=0.07). Presence vs. absence of HPR did not significantly moderate the risk associated with receiving ≤2.5 mm vs >2.5 mm stents in regard to MACE (adj HR 1.37, 95% CI 0.95-1.98 vs 1.18, 95% CI 0.81-1.71; pinteraction=0.56), MI (adj HR 1.45, 95% CI 0.94-2.24 vs 1.29, 95% CI 0.84-1.98; pinteraction=0.70), or ST (adj HR 1.28, 95% CI 0.56-2.94 vs 3.82, 95% CI 1.46-10.0; pinteraction=0.10).
PCI with small DES and HPR are both associated with a high risk of adverse events, including ST, although no specific interaction was noted between these risk conditions. Given higher absolute risk, potent antiplatelet therapies may be of particular benefit in pts with HPR after small diameter stent implantation.
Published In/Presented At
Redfors, B., Généreux, P., Witzenbichler, B., Kirtane, A. J., Mcandrew, T., Brodie, B., & ... Stone, G. (2017). TCT-732 Relationship Between Stent Diameter, Platelet Reactivity, and Adverse Events After PCI: Analysis from the ADAPT-DES study. Journal Of The American College Of Cardiology (JACC), 70B311. doi:10.1016/j.jacc.2017.09.967
Cardiology | Medical Sciences | Medicine and Health Sciences
Department of Medicine, Cardiology Division, Department of Medicine Faculty