Prevalence and impact of high platelet reactivity in chronic kidney disease: Results from the assessment of dual antiplatelet therapy with drug-eluting stents registry

Usman Baber, Roxana Mehran, Ajay J. Kirtane, Paul A. Gurbel, Georgios Christodoulidis, Akiko Maehara, Bernhard Witzenbichler, Giora Weisz, Michael J. Rinaldi, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest L. Mazzaferri, Ke Xu, Helen Parise, Bruce R. Brodie, Thomas D. Stuckey, Gregg W. Stone

Research output: Contribution to journalArticlepeer-review

66 Scopus citations

Abstract

Chronic kidney disease (CKD) is associated with increased rates of adverse events after percutaneous coronary intervention. We sought to determine the impact of CKD on platelet reactivity in clopidogrel-treated patients and whether high platelet reactivity (HPR) confers a similar or differential risk for adverse events among patients with CKD and non-CKD. Methods and Results-We performed a post hoc analysis of the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) registry, which included 8582 patients undergoing percutaneous coronary intervention with drug-eluting stents and platelet function testing using the VerifyNow assay. We compared HPR and its impact on ischemic and bleeding events >2 years among patients with CKD and non-CKD. Patients with CKD (n=1367) were older, more often female, diabetic, and had lower ejection fraction compared with their non-CKD counterparts (n=7043). Although HPR prevalence increased with worsening renal function in unadjusted analyses, these associations were no longer present after adjustment. Major adverse cardiac event rates at 2 years among those without CKD or HPR, HPR alone, CKD alone, and both CKD and HPR were 9.0%, 11.2%, 13.3%, and 17.5%, respectively (P<0.001). Associations between HPR and adverse events were uniform across CKD strata without evidence of interaction. Conclusions-HPR is more common among those with versus without CKD, an association that is attributable to confounding risk factors that are more prevalent in CKD. The impact of HPR on ischemic and bleeding events is similar irrespective of CKD status.

Original languageEnglish (US)
Article numbere001683
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number6
DOIs
StatePublished - Jun 20 2015

Bibliographical note

Publisher Copyright:
© 2015 American Heart Association, Inc.

Keywords

  • Blood platelet
  • kidney
  • stents

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