Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease: Results From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Registry

BACKGROUND—Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or diffe...

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Veröffentlicht in:Circulation. Cardiovascular interventions 2015-06, Vol.8 (6), p.e001683-e001683
Hauptverfasser: Baber, Usman, Mehran, Roxana, Kirtane, Ajay J, Gurbel, Paul A, Christodoulidis, Georgios, Maehara, Akiko, Witzenbichler, Bernhard, Weisz, Giora, Rinaldi, Michael J, Metzger, D Christopher, Henry, Timothy D, Cox, David A, Duffy, Peter L, Mazzaferri, Ernest L, Xu, Ke, Parise, Helen, Brodie, Bruce R, Stuckey, Thomas D, Stone, Gregg W
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container_issue 6
container_start_page e001683
container_title Circulation. Cardiovascular interventions
container_volume 8
creator Baber, Usman
Mehran, Roxana
Kirtane, Ajay J
Gurbel, Paul A
Christodoulidis, Georgios
Maehara, Akiko
Witzenbichler, Bernhard
Weisz, Giora
Rinaldi, Michael J
Metzger, D Christopher
Henry, Timothy D
Cox, David A
Duffy, Peter L
Mazzaferri, Ernest L
Xu, Ke
Parise, Helen
Brodie, Bruce R
Stuckey, Thomas D
Stone, Gregg W
description BACKGROUND—Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. METHODS AND RESULTS—We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P
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We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. METHODS AND RESULTS—We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events &gt;2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P&lt;0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. CONCLUSIONS—HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00638794.</description><identifier>ISSN: 1941-7640</identifier><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.115.001683</identifier><identifier>PMID: 26056248</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Aged, 80 and over ; Blood Platelets - physiology ; Coronary Artery Disease - complications ; Coronary Artery Disease - drug therapy ; Coronary Artery Disease - surgery ; Drug-Eluting Stents ; Female ; Hemorrhage - etiology ; Humans ; Ischemia - etiology ; Male ; Middle Aged ; Percutaneous Coronary Intervention - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Platelet Function Tests ; Prospective Studies ; Registries ; Renal Insufficiency, Chronic - blood ; Renal Insufficiency, Chronic - complications</subject><ispartof>Circulation. Cardiovascular interventions, 2015-06, Vol.8 (6), p.e001683-e001683</ispartof><rights>2015 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3098-32b041628b50e531e219f34a3d0da0bbc6fe220d90c46cb784b8f6abca41b4e73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26056248$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baber, Usman</creatorcontrib><creatorcontrib>Mehran, Roxana</creatorcontrib><creatorcontrib>Kirtane, Ajay J</creatorcontrib><creatorcontrib>Gurbel, Paul A</creatorcontrib><creatorcontrib>Christodoulidis, Georgios</creatorcontrib><creatorcontrib>Maehara, Akiko</creatorcontrib><creatorcontrib>Witzenbichler, Bernhard</creatorcontrib><creatorcontrib>Weisz, Giora</creatorcontrib><creatorcontrib>Rinaldi, Michael J</creatorcontrib><creatorcontrib>Metzger, D Christopher</creatorcontrib><creatorcontrib>Henry, Timothy D</creatorcontrib><creatorcontrib>Cox, David A</creatorcontrib><creatorcontrib>Duffy, Peter L</creatorcontrib><creatorcontrib>Mazzaferri, Ernest L</creatorcontrib><creatorcontrib>Xu, Ke</creatorcontrib><creatorcontrib>Parise, Helen</creatorcontrib><creatorcontrib>Brodie, Bruce R</creatorcontrib><creatorcontrib>Stuckey, Thomas D</creatorcontrib><creatorcontrib>Stone, Gregg W</creatorcontrib><title>Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease: Results From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Registry</title><title>Circulation. Cardiovascular interventions</title><addtitle>Circ Cardiovasc Interv</addtitle><description>BACKGROUND—Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. METHODS AND RESULTS—We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events &gt;2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P&lt;0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. CONCLUSIONS—HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00638794.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Platelets - physiology</subject><subject>Coronary Artery Disease - complications</subject><subject>Coronary Artery Disease - drug therapy</subject><subject>Coronary Artery Disease - surgery</subject><subject>Drug-Eluting Stents</subject><subject>Female</subject><subject>Hemorrhage - etiology</subject><subject>Humans</subject><subject>Ischemia - etiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Platelet Function Tests</subject><subject>Prospective Studies</subject><subject>Registries</subject><subject>Renal Insufficiency, Chronic - blood</subject><subject>Renal Insufficiency, Chronic - complications</subject><issn>1941-7640</issn><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkc1u1DAUhSMEoqXwCsgLFmxSrmPHSRCbUWZKI6ppNR1gGTnJzcTg_GA7rfJEvCaGabthceWro--cK_kEwTsK55QK-iEvdnmx3W923zbbfXG9vfVyfA5ARcqeBac04zRMBIueP-0cToJX1v4A8LKIXgYnkYBYRDw9DX7fGLyTGocaiRwaUvSTrB0ZW3KpDh250dKhRkd26GV1p9xC1EDyzoyDqskX1Qy4kLWyKC1-9JSdtbPkwow9cR2SlbVobY_Dv8j1LDVZDU5Nj7H7Do2cFvJduY6szXwIN3p2ajiQW-dN1icelHVmeR28aKW2-ObhPQu-Xmz2-WV4df25yFdXYc0gS0MWVcCpiNIqBowZxYhmLeOSNdBIqKpatBhF0GRQc1FXScqrtBWyqiWnFceEnQXvj7mTGX_NaF3ZK1uj1nLAcbal_-WEcSEY9-inI1qb0VqDbTkZ1UuzlBTKv1WV_1Xl5bg8VuXtbx8uzVWPzZP5sRsP8CNwP2qHxv7U8z2askOpXVcCZSzhWRxGQGMQABD6gZT9Ac3EpHk</recordid><startdate>201506</startdate><enddate>201506</enddate><creator>Baber, Usman</creator><creator>Mehran, Roxana</creator><creator>Kirtane, Ajay J</creator><creator>Gurbel, Paul A</creator><creator>Christodoulidis, Georgios</creator><creator>Maehara, Akiko</creator><creator>Witzenbichler, Bernhard</creator><creator>Weisz, Giora</creator><creator>Rinaldi, Michael J</creator><creator>Metzger, D Christopher</creator><creator>Henry, Timothy D</creator><creator>Cox, David A</creator><creator>Duffy, Peter L</creator><creator>Mazzaferri, Ernest L</creator><creator>Xu, Ke</creator><creator>Parise, Helen</creator><creator>Brodie, Bruce R</creator><creator>Stuckey, Thomas D</creator><creator>Stone, Gregg W</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201506</creationdate><title>Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease: Results From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Registry</title><author>Baber, Usman ; Mehran, Roxana ; Kirtane, Ajay J ; Gurbel, Paul A ; Christodoulidis, Georgios ; Maehara, Akiko ; Witzenbichler, Bernhard ; Weisz, Giora ; Rinaldi, Michael J ; Metzger, D Christopher ; Henry, Timothy D ; Cox, David A ; Duffy, Peter L ; Mazzaferri, Ernest L ; Xu, Ke ; Parise, Helen ; Brodie, Bruce R ; Stuckey, Thomas D ; Stone, Gregg W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3098-32b041628b50e531e219f34a3d0da0bbc6fe220d90c46cb784b8f6abca41b4e73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Platelets - physiology</topic><topic>Coronary Artery Disease - complications</topic><topic>Coronary Artery Disease - drug therapy</topic><topic>Coronary Artery Disease - surgery</topic><topic>Drug-Eluting Stents</topic><topic>Female</topic><topic>Hemorrhage - etiology</topic><topic>Humans</topic><topic>Ischemia - etiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Platelet Function Tests</topic><topic>Prospective Studies</topic><topic>Registries</topic><topic>Renal Insufficiency, Chronic - blood</topic><topic>Renal Insufficiency, Chronic - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baber, Usman</creatorcontrib><creatorcontrib>Mehran, Roxana</creatorcontrib><creatorcontrib>Kirtane, Ajay J</creatorcontrib><creatorcontrib>Gurbel, Paul A</creatorcontrib><creatorcontrib>Christodoulidis, Georgios</creatorcontrib><creatorcontrib>Maehara, Akiko</creatorcontrib><creatorcontrib>Witzenbichler, Bernhard</creatorcontrib><creatorcontrib>Weisz, Giora</creatorcontrib><creatorcontrib>Rinaldi, Michael J</creatorcontrib><creatorcontrib>Metzger, D Christopher</creatorcontrib><creatorcontrib>Henry, Timothy D</creatorcontrib><creatorcontrib>Cox, David A</creatorcontrib><creatorcontrib>Duffy, Peter L</creatorcontrib><creatorcontrib>Mazzaferri, Ernest L</creatorcontrib><creatorcontrib>Xu, Ke</creatorcontrib><creatorcontrib>Parise, Helen</creatorcontrib><creatorcontrib>Brodie, Bruce R</creatorcontrib><creatorcontrib>Stuckey, Thomas D</creatorcontrib><creatorcontrib>Stone, Gregg W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baber, Usman</au><au>Mehran, Roxana</au><au>Kirtane, Ajay J</au><au>Gurbel, Paul A</au><au>Christodoulidis, Georgios</au><au>Maehara, Akiko</au><au>Witzenbichler, Bernhard</au><au>Weisz, Giora</au><au>Rinaldi, Michael J</au><au>Metzger, D Christopher</au><au>Henry, Timothy D</au><au>Cox, David A</au><au>Duffy, Peter L</au><au>Mazzaferri, Ernest L</au><au>Xu, Ke</au><au>Parise, Helen</au><au>Brodie, Bruce R</au><au>Stuckey, Thomas D</au><au>Stone, Gregg W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease: Results From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Registry</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><addtitle>Circ Cardiovasc Interv</addtitle><date>2015-06</date><risdate>2015</risdate><volume>8</volume><issue>6</issue><spage>e001683</spage><epage>e001683</epage><pages>e001683-e001683</pages><issn>1941-7640</issn><eissn>1941-7632</eissn><abstract>BACKGROUND—Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. METHODS AND RESULTS—We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events &gt;2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P&lt;0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. CONCLUSIONS—HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status. CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT00638794.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>26056248</pmid><doi>10.1161/CIRCINTERVENTIONS.115.001683</doi></addata></record>
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subjects Aged
Aged, 80 and over
Blood Platelets - physiology
Coronary Artery Disease - complications
Coronary Artery Disease - drug therapy
Coronary Artery Disease - surgery
Drug-Eluting Stents
Female
Hemorrhage - etiology
Humans
Ischemia - etiology
Male
Middle Aged
Percutaneous Coronary Intervention - adverse effects
Platelet Aggregation Inhibitors - therapeutic use
Platelet Function Tests
Prospective Studies
Registries
Renal Insufficiency, Chronic - blood
Renal Insufficiency, Chronic - complications
title Prevalence and Impact of High Platelet Reactivity in Chronic Kidney Disease: Results From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Registry
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