052 Cardiovascular mortality in chronic kidney disease patients undergoing percutaneous coronary intervention is mainly related to impaired P2Y12 inhibition by clopidogrel

Abstract

Objectives To determine whether low platelet response to the P2Y 12 receptor antagonist clopidogrel as assessed by VAsodilator Stimulated Phosphoprotein flow cytometry test (VASP-FCT) has the same deleterious clinical impact in patients with or without chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Background Whilst both CKD and impaired platelet responsiveness to clopidogrel are strong predictors of unfavourable outcome after PCI, the deleterious impact of their association is unknown. The platelet VASP-FCT assay is specific of the P2Y 12 ADP receptor-pathway. In this test, platelet activation is expressed as Platelet Reactivity Index (PRI). Methods 440 unselected patients (CKD: 126 (eGFR 2 ), NoCKD: 314 eGFR>60 ml/min/1.73 m 2 ) undergoing urgent (n = 336) or planned (n = 104) PCI were prospectively enrolled. In each sub-group, patients were classified as low-responders (LR: PRI≥61%) and responders (R: PRI Results At a mean follow-up of 9 ± 2 months, cardiac death, probable and possible stent thrombosis rates were higher in CKD patients. In this sub-group, cardiac death, total stent thrombosis and MACE were dramatically increased in LR patients, especially when treated with drug eluting stent (DES). Conversely, in NoCKD patients, LR was not associated with poorer cardiovascular outcome. Multivariate analysis identified Killip class ≥3, DES implantation and the interaction between LR and CKD (HR 11.96 [1.22–116.82]; p = 0.033) as independent predictors of cardiac death. Conclusions In CKD patients, cardiovascular mortality following PCI is mainly related to impaired P2Y 12 inhibition.