Impact of Chronic Kidney Disease and Platelet Reactivity on Clinical Outcomes Following Percutaneous Coronary Intervention

J Cardiovasc Transl Res. 2021 Dec;14(6):1085-1092. doi: 10.1007/s12265-021-10126-8. Epub 2021 Apr 13.

Abstract

We investigated the interaction between chronic kidney disease (CKD) and high platelet reactivity (HPR) in determining long-term clinical outcomes following elective PCI for stable coronary artery disease (CAD). A total of 500 patients treated with aspirin and clopidogrel were divided based on the presence of CKD (defined as glomerular filtration rate of < 60 ml/min/1.73 m2) and HPR (defined as a P2Y12 reaction unit value ≥ 240 at VerifyNow assay). Primary endpoint was the occurrence of major adverse clinical events (MACE) at 5 years. Patients with both CKD and HPR showed the highest estimates of MACE (25.6%, p = 0.005), all-cause death (17.9%, p = 0.004), and cardiac death (7.7%, p = 0.004). The combination of CKD and HPR was an independent predictor of MACE (HR 3.12, 95% CI 1.46-6.68, p = 0.003). In conclusion, the combination of CKD and HPR identifies a cohort of patients with the highest risk of MACE at 5 years.

Keywords: Chronic kidney disease; Coronary artery disease; Percutaneous coronary intervention; Platelet reactivity.

MeSH terms

  • Aged
  • Coronary Angiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention*
  • Plaque, Atherosclerotic / diagnostic imaging*
  • Platelet Count
  • Platelet Function Tests*
  • Registries
  • ST Elevation Myocardial Infarction / blood
  • ST Elevation Myocardial Infarction / diagnostic imaging*
  • ST Elevation Myocardial Infarction / surgery*
  • Sensitivity and Specificity
  • Tomography, Optical Coherence*