Impact of renal failure and high-platelet reactivity on major cardiovascular ischemic events among patients with acute coronary syndrome receiving dual antiplatelet therapy with ticagrelor.

Abstract

No study has so far evaluated the impact of chronic kidney disease (CKD) on high-on treatment platelet reactivity (HRPR) with ticagrelor and their prognostic consequences, that were therefore the aim of the present study. Patients on dual antiplatelet therapy with ASA+ticagrelor (90mg/twice a day) after percutaneous coronary revascularization for ACS were scheduled for platelet function assessment 30-90 days post-discharge. The primary study endpoint was defined as the occurrence of major cardiovascular events (a composite of cardiovascular death, recurrent acute coronary syndrome (MI), target vessel revascularization) at the longest available follow-up. We included 396 patients, that were divided according to CKD (eGFR <or≥ 60 mL/min). Mean platelet reactivity was comparable irrespective of renal function Prevalence of high platelet reactivity (HRPR) on Ticagrelor was similar among patients with or without CKD (9.7% vs. 11.8%, P=0.84). At a mean follow-up of 939±581.4 days, 21.2% of the patients experienced the primary composite endpoint, with a similar rate of events in patients CKD or normal renal function (22.2% vs. 21.2% HR [95%CI]= 0.92[0.52-1.61], P=0.77), and no difference in survival, ischemic and bleeding endpoints. After correction for baseline differences CKD did not emerge as an independent predictor of either HRPR (adjusted OR [95%CI]=0.47 [0.18;1.25], P=0.13) or MACE (adjusted HR [95%CI]=0.66 [0.34-1.29] P=0.18). In the present study we demonstrated that among ACS patients on DAPT with ASA and ticagrelor after PCI, renal failure is not associated with a higher rate of HRPR or to an increased risk of mortality or major ischemic and bleeding events.