Iijima Raisuke, Kadota Kazushige, Nakao Koichi, Nakagawa Yoshihisa, Shite Junya, Yokoi Hiroyoshi, Kozuma Ken, Tanabe Kengo, Akasaka Takashi, Shinke Toshiro, Ueno Takafumi, Hirayama Atsushi, Uemura Shiro, Harada Atsushi, Kuroda Takeshi, Takita Atsushi, Murakami Yoshitaka, Saito Shigeru, Nakamura Masato
Division of Cardiovascular Medicine, Toho University Ohashi Medical Center.
Department of Cardiology, Kurashiki Central Hospital.
Circ J. 2022 Apr 25;86(5):763-771. doi: 10.1253/circj.CJ-21-0717. Epub 2021 Dec 8.
The balance between thrombotic and bleeding risk is of great concern in high bleeding risk (HBR) patients. This study evaluated the relationship between perioperative antiplatelet reactivity and thrombotic and bleeding events in patients at HBR undergoing percutaneous coronary intervention (PCI).
In this post hoc analysis of the PENDULUM (Platelet rEactivity in patieNts with DrUg eLUting stent and balancing risk of bleeding and ischeMic event) registry, patients undergoing PCI were categorized as HBR or non-HBR, and stratified as having high platelet reactivity (HPR; P2Yreaction unit [PRU] >208) or non-HPR (PRU ≤208). Cumulative incidences of cardiovascular and cerebrovascular events (Journal of the American College of Cardiology expert definitions) and bleeding events (Bleeding Academic Research Consortium criteria) were assessed 12 months after index PCI. The incidence of ischemic and bleeding events was ~3-fold higher in HBR vs. non-HBR patients. Thrombotic/ischemic events were significantly more common in the HPR subgroup in HBR patients (hazard ratio [HR]: 1.59; 95% confidence interval [CI]: 1.11-2.28; P=0.012), but there was no difference in non-HBR patients. After adjustment for covariates, HPR in HBR patients remained an independent factor for thrombotic and ischemic events (HR: 1.69; 95% CI: 1.13-2.54; P=0.011), but not for bleeding events (HR: 1.56; 95% CI: 0.78-3.11; P=0.210).
Maintaining adequate PRU levels during PCI is an important factor in improving clinical outcomes, especially for HBR patients.
在高出血风险（HBR）患者中，血栓形成风险与出血风险之间的平衡备受关注。本研究评估了接受经皮冠状动脉介入治疗（PCI）的HBR患者围手术期抗血小板反应性与血栓形成及出血事件之间的关系。
在对PENDULUM（药物洗脱支架患者的血小板反应性及出血与缺血事件平衡）注册研究进行的这项事后分析中，接受PCI的患者被分为HBR或非HBR，并进一步分层为高血小板反应性（HPR；P2Y反应单位[PRU]＞208）或非HPR（PRU≤208）。在首次PCI术后12个月评估心血管和脑血管事件（美国心脏病学会专家定义）以及出血事件（出血学术研究联盟标准）的累积发生率。HBR患者的缺血和出血事件发生率比非HBR患者高约3倍。HBR患者的HPR亚组中血栓形成/缺血事件明显更常见（风险比[HR]：1.59；95%置信区间[CI]：1.11 - 2.28；P = 0.012），但在非HBR患者中无差异。在对协变量进行调整后，HBR患者中的HPR仍然是血栓形成和缺血事件的独立因素（HR：1.69；95% CI：1.13 - 2.54；P = 0.011），但不是出血事件的独立因素（HR：1.56；95% CI：0.78 - 3.11；P = 0.210）。
在PCI期间维持适当的PRU水平是改善临床结局的重要因素，尤其是对于HBR患者。
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