Circ Cardiovasc Interv. 2025;18(10):e015737.
Long-Term Impact of Platelet Reactivity and Clinical Risk on Clinical Outcomes in Patients With Coronary Artery Disease: Analysis of the PTRG-DES Registry.
제1저자 강지훈, 박성준 · 교신저자 박경우
소속 (13)
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital and Seoul National University College of Medicine, South Korea (J.K., S.P., K.W.P., D.H., J.-K.H., H.-M.Y., B.-K. Koo, H.-S.K.).
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea (H.J.J., D.-S.L.).
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul, South Korea (K.C.).
- Cardiovascular Center, Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea (Y.P.).
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (Y.B.S.).
- Department of Cardiology, Yonsei University Wonju Severance Christian Hospital, South Korea (S.G.A.).
- Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea (J.-W.S.).
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, South Korea (S.Y.L., Y.-H.J.).
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea (J.R.C.).
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea (A.-Y.H.).
- Severance Cardiovascular Hospital, Seoul, South Korea (B.-K. Kim).
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea (M.H.K.).
- Division of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea (E.-S.S.).
Abstract
BACKGROUND Platelet reactivity (PR) and clinical risk factors are known to have impact on outcomes in patients receiving percutaneous coronary intervention (PCI). We aimed to assess the interaction of PR and clinical risk assessment using the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS2P) on adverse clinical outcomes following PCI.
METHODS From the PTRG-DES (Platelet function and Genotype-Related Long-Term Prognosis in Drug-Eluting Stent-Treated Patients With Coronary Artery Disease) registry, 11 714 patients who underwent PCI and had a mean platelet reactivity unit (PRU) value were studied. Clinical risk was stratified using the TRS2P as low clinical risk (score 0-1) or high clinical risk (≥2), and PR was stratified as high PR (HPR, PRU ≥252) and non-HPR (PRU <252). The primary outcome was a composite of cardiac death, myocardial infarction, and stent thrombosis. Landmark analysis was performed at 1- and 12 months after PCI.
RESULTS Among total population, mean PRU was 217.8±78.7, and mean TRS2P was 1.56±1.12. Over the long-term follow-up period, the primary outcome occurred in 335 (5.3%) patients. Patients with both high clinical risk and HPR had the highest incidence of the primary outcome (9.4%), followed by high clinical risk/non-HPR (5.9%), low clinical risk/HPR (4.8%), and low clinical risk/non-HPR (3.9%) (P<0.001). Compared with low clinical risk/non-HPR patients, those with both high clinical risk and HPR had a 3.25-fold higher risk of the primary outcome (hazard ratio, 3.25 [95% CI, 2.38-4.42]; P<0.001). Both PRU and TRS2P were independent predictors of the primary outcome. In landmark analyses, the risk of primary outcome within 1 month after PCI were mainly determined by PRU, while outcome beyond 1 month after PCI was mainly determined by TRS2P.
CONCLUSIONS In the secondary prevention after percutaneous coronary intervention, platelet reactivity and clinical risk had additive value in predicting outcomes. Platelet reactivity had greater relative impact within 1 month while clinical risk had greater relative impact beyond 1 month.
REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04734028.
Keywords
coronary artery diseasedrug-eluting stentshumansincidencepercutaneous coronary interventionrisk factors
Conflict of interest statement
Dr Jeong has received honoraria for lectures from AstraZeneca, Daiichi Sankyo, Sanofi-Aventis, Hanmi Pharmaceuticals, and Yuhan Pharmaceuticals, and research grants or support from Yuhan Pharmaceuticals and U&I Corporation. Dr Song has received honoraria for lectures from AstraZeneca, Daiichi Sankyo, Sanofi-Aventis, Bayer Korea, and Samjin Pharmaceutical. Dr Joo has received honoraria for lectures from AstraZeneca, Hanmi, Samjin, Dong-A, HK inno.N Pharmaceuticals, and DIO Medical, Ltd. The other authors report no conflicts.
그 밖의 정보
- 출판 형태
- Journal Article, Multicenter Study, Observational Study
- 저널
- Circulation. Cardiovascular interventions · eISSN 1941-7632
- 전자 출판
- 2025-09-22
- MeSH
- Humans · Male · Female · Registries · Coronary Artery Disease* / therapy / blood / mortality / diagnosis · Percutaneous Coronary Intervention* / adverse effects / mortality / instrumentation · Middle Aged · Aged · Drug-Eluting Stents* · Treatment Outcome · Risk Assessment · Blood Platelets* / metabolism / drug effects · Risk Factors · Time Factors · Myocardial Infarction / etiology / mortality / blood · Platelet Aggregation Inhibitors / therapeutic use · Platelet Function Tests · Platelet Activation*
- Substances
- Platelet Aggregation Inhibitors
- 데이터
- ClinicalTrials.gov: NCT04734028