接受药物洗脱支架置入术治疗的患者中根据左心室收缩功能障碍状态评估血小板反应性的预后意义：PTRG-DES 联盟分析。
Prognostic Implication of Platelet Reactivity According to Left Ventricular Systolic Dysfunction Status in Patients Treated With Drug-Eluting Stent Implantation: Analysis of the PTRG-DES Consortium.
机构信息
Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Seoul National University College of Medicine and Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea.
出版信息
J Korean Med Sci. 2024 Jan 22;39(3):e27. doi: 10.3346/jkms.2024.39.e27.
BACKGROUND
Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated.
METHODS
From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3-5.
RESULTS
A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, < 0.001, 95% confidence interval [CI] 1.85-2.55; major bleeding: HR 1.78, < 0.001, 95% CI 1.39-2.78). The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group, < 0.01, 95% CI 2.51-3.91). The frequency of major bleeding was not associated with the HPR in either group.
CONCLUSION
LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04734028.
背景
经皮冠状动脉介入治疗（PCI）的冠心病患者常表现出左心室射血分数（LVEF）降低。然而，LV 功能状态与血小板反应性对临床结局的影响尚未得到先前的研究。
方法
来自多中心 PTRG-DES（经 DES 治疗患者的血小板功能和基因型相关长期预后）联盟，通过超声心动图将患者分为射血分数保留组（PEF：LVEF≥50%）和射血分数降低组（REF：LVEF<50%）。使用 VerifyNow P2Y 测定法测量血小板反应性，高血小板反应性（HPR）定义为 PRU≥252。主要不良心脏和脑血管事件（MACCEs）是 PCI 后 5 年内死亡、心肌梗死、支架血栓形成和卒中的复合终点。主要出血定义为 Bleeding Academic Research Consortium 出血类型 3-5。
结果
来自 PTRG-DES 的 13160 例患者中，有 9319 例（79.6%）同时具有 PRU 和 LVEF 结果，对其进行了分析。REF 组的 MACCE 和主要出血发生率高于 PEF 组（MACCEs：风险比[HR]2.17，<0.001，95%置信区间[CI]1.85-2.55；主要出血：HR 1.78，<0.001，95% CI 1.39-2.78）。REF 和 HPR 患者的 MACCEs 发生率最高，组间差异具有统计学意义（HR 3.14 在 REF(+)/HPR(+)与 PEF(+)/HPR(-)组，<0.01，95% CI 2.51-3.91）。在任何一组中，HPR 状态均与主要出血的发生无关。
结论
LV 功能障碍与 PCI 患者 MACCEs 和主要出血发生率增加有关。在一个大型真实世界的注册研究中，HPR 状态在 LV 功能障碍患者中进一步显著增加了 MACCEs 的发生。
临床试验注册号
NCT04734028。
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