Low On‐Treatment Platelet Reactivity Predicts Long‐Term Risk of Bleeding After Elective PCI |
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| Authors: | Mirko D ?oli? MD BSc Branko M ?alija MD Bratislav M Milosavljevi? MD Aleksandra G Grdini? MD Lazar G Angelkov MD PhD Dragan ? Sagi? MD PhD Peter Kruzliak MD PhD Jelena M Marinkovi? MD PhD Rade M Babi? MD PhD FSCAI Igor B Mrdovi? MD PhD |
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| Institution: | 1. Dedinje Cardiovascular Institute, Belgrade, Serbia;2. Cardiology Clinic, Military Academy, Belgrade, Serbia;3. International Clinical Research Center, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic;4. School of Medicine, Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia;5. Urgent Cardiology, Emergency Hospital, Clinical Centre of Serbia, Belgrade, Serbia |
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| Abstract: | Background Bleeding after percutaneous coronary interventions (PCI) is an important complication with impact on prognosis. Aim To evaluate the predictive value of enhanced platelet responsiveness to dual antiplatelet therapy with aspirin and clopidogrel, for bleeding, after elective PCI. Methods and Results We performed multiple electrode aggregometry (MAE) platelet functional tests induced by arachidonic acid (ASPI) and adenosine‐diphosphate (ADP) before PCI, and 24 hours after PCI, in 481 elective PCI patients who were followed‐up for an average of 15.34 ± 7.19 months. Primary end point was the occurrence of any bleeding, while ischemic major adverse cardiovascular event (MACE) was a secondary endpoint. The incidence of total, BARC ≤ 2, and BARC ≥ 3 bleeding, according to BARC classification, was 19, 18, and 1%, respectively. Groups with any, and BARC ≤ 2 bleeding, had a lower average value of MAE ADP test after 24 hours, compared to the group without bleeding: 45.30 ± 18.63 U versus 50.99 ± 19.01 U; P = 0.005; and 45.75 ± 18.96 U versus 50.99 ± 18.99 U; P = 0.01; respectively. Female gender (HR 2.11; CI 1.37–3.25; P = 0.001), previous myocardial infarction (HR 0.56; CI 0.37–0.85; P = 0.006), lower body mass (HR 0.78; CI 0.62–0.98; P = 0.03), and MAE ADP test after 24 hours (HR 0.75; CI 0.61–0.93; P = 0.009) were the independent predictors for any bleeding by Cox univariate analysis. After adjustment, MAE ADP test after 24 hours, was the only independent predictor for any (HR 0.7; CI 0.56–0.87; P = 0.002), and BARC ≤ 2 (HR 0.71; CI 0.56–0.89; P = 0.003) bleeding, by Cox multivariate analysis. Conclusion MAE ADP test before and after PCI, was associated with any, and BARC ≤ 2 bleeding after elective PCI. |
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