Abstract
Introduction: Individualized antithrombotic therapy guided by platelet function testing is a hot topic in current study. However, the prognostic value of platelet function testing for long-term ischemic events in percutaneous coronary intervention (PCI) population is still unknown. Objective: To investigate whether platelet function testing (reflected by adenosine diphosphate-induced platelet maximum amplitude [MA ADP ] based on thromboelastogram) is associated with five-year ischemic events in patients undergoing PCI. Methods: 10,724 consecutive patients undergoing PCI in 2013 were enrolled. The traditional cut-off point of MA ADP (47) and the optimal cut-off point of MA ADP (41.8) according to receiver operating curve were selected. The primary endpoint was cardiovascular death. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, ischemic revascularization, and stroke. Results: A total of 6,290 patients (mean age, 58.27 ± 10.30; male, 77.5%) who had both MA ADP results and completed follow-up were finally included. After five-year follow-up, 143 (2.3%) cardiovascular death and 1,410 (22.4%) MACCE occurred. According to the traditional cut-off point, multivariate COX regression analysis (Figure 1) showed no prognostic value of MA ADP for both cardiovascular death and MACCE (all P >0.05). As for the optimal cut-off point, multivariate COX regression analysis (Figure 2) showed that MA ADP ≥ 41.8 was independently associated with cardiovascular death (HR=1.484, 95% CI: 1.043-2.111, P =0.028) and MACCE (HR=1.138, 95% CI: 1.018-1.272, P =0.023). Conclusions: Our study is the first to report that platelet function testing can help identify individuals at high risk of long-term ischemic events. We proposed a new cut-off point of MA ADP to assess the prognosis of ischemic events, and demonstrated that MA ADP ≥ 41.8 was associated with five-year cardiovascular death and MACCE.
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