Peripheral artery disease associated to ischemic and bleeding events after DES implantation

Patients with peripheral artery disease (PAD) have higher rates of cardiovascular events after DES implantation, which could be explained partly by higher platelet reactivity. The present work studies the relationship between platelet reactivity and clinical events after PCI in patients with and without a history of peripheral artery disease.

The ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective multicenter registry of patients with peripheral artery disease treated with DES. Platelet reactivity was measured with VerifyNow, and elevated on-treatment platelet reactivity was defined as P2Y12 reaction units >208.

A propensity adjusted multivariable analyzis was performed to determine the relationship between PAD, platelet reactivity and subsequent adverse events (defined as definite/probable stent thrombosis, all-cause mortality, acute myocardial infarction and clinically relevant bleeding).

Of 8582 patients, 10.2% had a history of peripheral artery disease.

Patients with peripheral artery disease were older and had more comorbidities. However, on-treatment P2Y12 reactivity did not result significantly different between patients with and without PAD.

PAD patients showed higher all-cause mortality at 2 years: acute MI, stent thrombosis and clinically relevant bleeding.

Those with high platelet reactivity showed, as expected, more events, regardless of a history of PAD.

In a propensity adjusted multivariable analyzis, both platelet reactivity and PAD were independent predictors of acute MI at 2 years.

Conclusion

A history of peripheral artery disease was associated to ischemic and bleeding events 2 years after DES stenting, but this association seems not to be directly mediated by higher platelet reactivity.

Original Title: Platelet Reactivity and Clinical Outcomes after Coronary Artery Implantation of Drug-Eluting Stents in Subjects with Peripheral Arterial Disease. Analysis from the ADAPT-DES Study (Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents).

Reference: Rajesh Gupta et al. Circ Cardiovasc Interv. 2017;10:e004904.

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