Hypertension is associated with vascular and endothelial dysfunction that may result
in a greater propensity for reactive platelets to cause thrombosis. We sought to assess
whether the risk of major adverse cardiac events (MACE) after percutaneous coronary
intervention (PCI) in patients with on-clopidogrel residual high platelet reactivity
(HPR) varies in patients with versus without hypertension. Assessment of dual antiplatelet
therapy with drug eluting stents (ADAPT-DES) was a prospective, multicenter registry
of patients successfully treated with coronary drug-eluting stents (DES). HPR was
defined as P2Y12 reaction units (PRU) >208, as assessed by the VerifyNow point-of-care
assay. Multivariable Cox proportional hazards regression was used to assess whether
the adjusted association between HPR and 2-year risk of MACE (cardiac death, myocardial
infarction [MI], or stent thrombosis) was different in patients with versus without
hypertension. A total of 6833 of 8582 patients (79.6%) had a history of hypertension.
Patients with compared with those without hypertension were older, more likely to
have other cardiovascular risk factors, and had higher PRU (190.1 ± 97.3 vs 179.5
± 94.3; p <0.0001). Patients with hypertension had significantly higher 2-year rates
of MACE (7.0% vs 4.4%, p <0.001), all-cause death (4.2% vs 2.5%, p = 0.001), and MI
(5.2% vs 3.2%, p <0.001), and had nominally higher rates of stent thrombosis (1.0%
vs 0.5%, p = 0.059). A significant interaction was present between hypertension and
HPR regarding 2-year MACE risk (adjusted hazard ratio for HPR vs no HPR 1.38, 95%
confidence interval 1.14 to 1.68 for patients with hypertension vs 0.81, 95% confidence
interval 0.50 to 1.33 for patients without hypertension, p = 0.046). In conclusion,
following successful PCI with DES, 2-year MACE rates are increased in patients with
both hypertension and residual HPR on clopidogrel. HPR had a greater effect on the
risk of adverse events among patients with versus without hypertension.
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Article info
Publication history
Published online: August 07, 2019
Received in revised form:
July 15,
2019
Received:
July 10,
2019
Footnotes
Funding Sources: ADAPT-DES was sponsored by CRF with research support from Boston Scientific, Abbott Vascular, Medtronic, Cordis, Biosensors, The Medicines Company, Daiichi Sankyo, Eli Lilly, Volcano, and Accumetrics.
Identification
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© 2019 Elsevier Inc. All rights reserved.
