Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Clinical Medicine, National University Corporation Kyushu University, Fukuoka, Japan.
Heart Vessels. 2022 Jun;37(6):942-953. doi: 10.1007/s00380-021-02003-w. Epub 2022 Jan 1.
In patients undergoing percutaneous coronary intervention (PCI) with a stent, high on-treatment platelet reactivity may be associated with an increased risk of stroke. This post hoc analysis of the PENDULUM registry compared the risk of post-PCI stroke according to on-treatment P2Y reaction unit (PRU) values. Patients aged ≥ 20 years who underwent PCI were stratified by baseline PRU (at 12 and 48 h post-PCI) as either high (HPR, > 208), optimal (OPR, > 85 to ≤ 208), or low on-treatment platelet reactivity (LPR, ≤ 85). The incidences of non-fatal ischemic and non-ischemic stroke through to 12 months post-PCI were recorded. Almost all enrolled patients (6102/6267 [97.4%]) had a risk factor for ischemic stroke, and most were receiving dual antiplatelet therapy. Of the 5906 patients with PRU data (HPR, n = 2227; OPR, n = 3002; LPR, n = 677), 47 had a non-fatal stroke post-PCI (cumulative incidence: 0.68%, ischemic; 0.18%, non-ischemic stroke). Patients with a non-fatal ischemic stroke event had statistically significantly higher post-PCI PRU values versus those without an event (P = 0.037). The incidence of non-fatal non-ischemic stroke was not related to PRU value. When the patients were stratified by PRU ≤ 153 versus > 153 at 12-48 h post-PCI, a significant difference was observed in the cumulative incidence of non-fatal stroke at 12 months (P = 0.044). We found that patients with ischemic stroke tended to have higher PRU values at 12-48 h after PCI versus those without ischemic stroke.Clinical trial registration: UMIN000020332.
在接受经皮冠状动脉介入治疗（PCI）和支架置入的患者中，治疗过程中的血小板高反应性可能与中风风险增加有关。本项 PENDULUM 注册研究的事后分析比较了根据治疗后 P2Y 反应单位（PRU）值的 PCI 后中风风险。年龄≥20 岁的接受 PCI 的患者根据基线 PRU（PCI 后 12 和 48 小时）分为高反应性（HPR，>208）、最佳反应性（OPR，>85 至≤208）和低反应性（LPR，≤85）。记录 PCI 后 12 个月内非致命性缺血性和非缺血性中风的发生率。几乎所有入组患者（6267 例中的 6102 例[97.4%]）均存在缺血性中风的危险因素，且大多数患者正在接受双联抗血小板治疗。在有 PRU 数据的 5906 例患者中（HPR，n=2227；OPR，n=3002；LPR，n=677），47 例患者发生 PCI 后非致命性中风（累积发生率：0.68%，缺血性；0.18%，非缺血性中风）。发生非致命性缺血性中风事件的患者与无事件患者相比，PCI 后 PRU 值明显更高（P=0.037）。非致命性非缺血性中风的发生率与 PRU 值无关。当根据 PCI 后 12-48 小时 PRU 值≤153 与>153 将患者分层时，12 个月时非致命性中风的累积发生率存在显著差异（P=0.044）。我们发现，与无缺血性中风的患者相比，发生缺血性中风的患者 PCI 后 12-48 小时的 PRU 值往往更高。临床试验注册：UMIN000020332。
