title: Impact of chronic kidney disease on platelet reactivity and outcomes of patients receiving clopidogrel and undergoing percutaneous coronary intervention.
abstract: The impact of chronic kidney disease (CKD) on residual platelet reactivity (PR) in patients undergoing percutaneous coronary intervention (PCI) is still debatable. We sought to investigate the interaction between PR and renal function and the related clinical outcomes in patients with coronary artery disease treated with PCI. Immediately before PCI, we measured PR (as P2Y12 reaction units [PRUs]) in 800 patients on clopidogrel with the VerifyNow P2Y12 assay. High PR was defined as a PRU value of ≥240 and low PR as a PRU value of ≤178. Based on a glomerular filtration rate of < or ≥60 ml/min/1.73 m2, patients were respectively grouped into those with or without moderate-to-severe CKD. Primary end point was the incidence of 30-day net adverse clinical events (NACEs). Patients with moderate-to-severe CKD (n=173, 21.6%) and those without showed similar PRU values (208±67 vs 207±75, p=0.819). Yet, NACEs were significantly higher in patients with moderate-to-severe CKD (19.7% vs 9.1%, p<0.001), in terms of both ischemic (12.1% vs 7.2%, p=0.036) and bleeding events (8.7% vs 2.1%, p<0.001). NACEs were significantly higher when moderate-to-severe CKD was associated with either high PR or low PR (25.4%, p for trend<0.001); this association was the strongest predictor of NACE at multivariate analysis (odds ratio 3.4, 95% confidence interval 2.0 to 5.6, p<0.001). In conclusion, we did not find an association between moderate-to-severe CKD and residual PR on clopidogrel. However, the association of moderate-to-severe CKD with either high or low PR was a strong determinant of adverse events after PCI.
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. Electronic address: f.mangiacapra@unicampus.it.
authors: Fabio
authors: F
authors: Mangiacapra
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
authors: Ilaria
authors: I
authors: Cavallari
authors: Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
authors: Emanuele
authors: E
authors: Barbato
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
authors: Elisabetta
authors: E
authors: Ricottini
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
authors: Giuseppe
authors: G
authors: Patti
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
authors: Vincenzo
authors: V
authors: Vizzi
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
authors: Andrea
authors: A
authors: D'Ambrosio
authors: Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
authors: Bernard
authors: B
authors: De Bruyne
authors: Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
authors: William
authors: W
authors: Wijns
authors: Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.
authors: Germano
authors: G
authors: Di Sciascio
mesh_terms: D000368:Aged; D001792:Blood Platelets / Q000378:metabolism*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine