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ȣ - 540682 5 |
| Clinical characteristics of patients who have high post-treatment
platelet reactivity after triple antiplatelet therapy : A post-hoc
analysis of the CILON-T trial |
| 서울대학교 병원¹ , 분당서울대학교 병원² , 고려대학교구로병원³ , 건양대학교병원⁴, 충북대학교병원5 |
| 강도윤¹, 서정원¹ ,이승표¹ ,박경우¹ ,이해영¹ ,강현재¹ ,구본권¹ ,조영석² ,연태진² ,채인호² ,최동주², 나승운³ ,배장호⁴ ,권택근⁴ ,배장환5 ,조명찬5 ,김효수¹ |
Background – High post-treatment platelet reactivity (HPPR) after antiplatelet therapy is associated with an increased risk of atherothrombotic events. The addition of cilostazol on top of dual antiplatelet therapy (DAT) has been reported to decrease platelet reactivity in patients who have resistance to clopidogrel. In this study, we aimed to investigate the antiplatelet effect of triple antiplatelet therapy (TAT) and clinical characteristics of patients with HPPR even after TAT.
Methods – In the CILON-T trial, total 358 patients with coronary DES implantation reiceived TAT and underwent platelet function measurements (VerifyNow P2Y12 assay) at discharge after the index procedure. We analyzed distribution of P2Y12 reaction unit (PRU) in these patients and clinical characteristics of patients who have highest tertile of PRU level(PRU>255). We also investigated the association of HPPR after TAT and atherothrombotic events (cardiac death, nonfatal myocardial infarction, stent thrombosis and ischemic stroke) within six months after PCI.
Results – 358 patients (male 243(67.9%), age 62.8±9.5 years, BMI 24.9±2.9, DM 36%, hypertension 64.2%) enrolled and mean PRU value was 206.6 (median 214, range 7-390, interquartile range : 146-274).
In the univariate analysis, female sex (45.8% vs 25.2%, p<0.001), increased age (65.6±7.8 vs 61.3±9.9, p<0.001), non-smoker (82.5% vs 73.1%, p=0.049), hypertension (74.2% vs 59.2%, p=0.005), lower hematocrit (38.2±4.9 vs 40.9±4.3, p<0.001), Advanced CKD (Stage 3-5, 32.2% vs 21.8%, p=0.034) were more frequent in the patients with HPPR after TAT.
In the multivariate logistic regression analysis, independent predictors of HPPR after TAT were every increase of age (OR 1.042, 95% CI 1.013-1.072, p=0.004), every decrease of hematocrit (OR 0.900, 95% CI 0.846-0.957, p=0.001).
Composite of atherothrombotic events within six months after the index procedure was associated with tertile distribution of PRU levels (1st 0.0%, 2nd 1.7%, 3rd 3.3%, p=0.045).
Conclusions - Post-treatment platelet reactivity showed interindividual variability even after TAT. Old age and low hematocrit were independent predictors of HPPR after TAT. HPPR to TAT had association with atherothrombotic events after PCI.
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