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Circ Cardiovasc Interv. 2015 Jun;8(6):e001683. doi: 10.1161/CIRCINTERVENTIONS.115.001683.

Prevalence and impact of high platelet reactivity in chronic kidney disease: results from the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents registry.

Author information

1
From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork-Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (T.D.H.); Lehigh Valley Health Network, Allentown, PA (D.A.C.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); The Ohio State University Wexner Medical Center, Columbus (E.L.M.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.).
2
From the Icahn School of Medicine at Mount Sinai, New York (U.B., R.M., G.C.); Cardiovascular Research Foundation, New York (R.M., A.J.K., A.M., G.W., K.X., H.P., G.W.S.); NewYork-Presbyterian/Columbia University Medical Center, New York, NY (A.J.K., A.M., G.W., G.W.S.); Sinai Hospital of Baltimore, MD (P.A.G.); Helios Amper-Klinikum, Dachau, Germany (B.W.); Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); Sanger Heart and Vascular Institute/Carolinas HealthCare System, Charlotte, NC (M.J.R.); Wellmont CVA Heart Institute, Kingsport, TN (D.C.M.); Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, MN (T.D.H.); Lehigh Valley Health Network, Allentown, PA (D.A.C.); Reid Heart Center, FirstHealth of the Carolinas, Pinehurst, NC (P.L.D.); The Ohio State University Wexner Medical Center, Columbus (E.L.M.); and LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, NC (B.R.B., T.D.S.). roxana.mehran@mssm.edu.

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 >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<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:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.

KEYWORDS:

blood platelet; kidney; stents

[Indexed for MEDLINE]

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