Abstract 18394: Predicting Value of Platelet Reactivity on Bleeding and Major Adverse Cardiac Events in Eastern Asian PCI Patients

Abstract

Introduction: Previous studies have shown that high and low platelet reactivity (HPR and LPR respectively) are associated with adverse events following percutaneous coronary intervention (PCI), however, therapy windows were not consistent in different studies. We aimed to determine the optimal cutoff value of platelet reactivity to prevent major adverse cardiac events (MACE) and bleeding in eastern Asian PCI patients. Methods: Consecutive 6266 non-emergent PCI patients with aspirin and clopidogrel therapy were enrolled prospectively in the single-center, large-volume investigation from January to December 2013. Platelet reactivity (ADP-induced platelet-fibrin clot strength [MAADP]) was determined by thrombelastography. MACE and Bleeding Academic Research Consortium (BARC) classification≥2 bleeding were assessed between different categories of platelet reactivity and Syntax Score (SS). Results: Overall, 475 MACE and 152 major bleeding (BARC grade≥2) events were recorded during one year follow-up. With receiver operating characteristic (ROC) curve, we determined the cutoff values of MAADP for MACE and major bleeding (45 mm and 34mm, respectively). Then, patients were classified according to MAADP (>45 mm, 34-45 mm, and <34 mm) and we evaluated the impact of platelet reactivity on MACE and major bleeding in different Syntax Score subgroups (SS45 mm was the predictor of MACE (HR: 2.3; 95%CI: 1.6-5.9), but MAADP45 mm was still the predictor of MACE (HR: 2.6; 95%CI: 1.3-6.3), while MAADP<34 mm show significant impact on major bleeding (HR: 1.8; 95%CI: 1.2-4.7). Conclusions: Platelet reactivity measured by thrombelastography could predict MACE and major bleeding in elective PCI patients, especially in those with high SS. Therapy window of anti-platelet drugs is narrow in eastern Asian population and further studies on tailored treatment of high-risk patients are needed.