title: The net clinical benefit of personalized antiplatelet therapy in patients undergoing percutaneous coronary intervention.
abstract: This was a prospective study comparing two groups: personalized and non-personalized treatment with P2Y12 receptor blockers during a 12-month follow-up. We aimed to investigate whether personalized antiplatelet treatment in patients with high on-treatment platelet reactivity (HTPR) improves clinical outcome. Platelet reactivity was assessed by adenosine diphosphate induced aggregation using a multiple electrode aggregometry (MEA) in 798 patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). Patients with HTPR received up to four repeated loading doses of clopidogrel or prasugrel in the personalized treatment group (n=403), whereas no change in the treatment strategy was undertaken in patients with HTPR in the non-personalized treatment group (n=395). There were fewer major adverse cardiac events (MACE) in the personalized treatment group than in the non-personalized treatment group (7.4% compared with 15.3% respectively; P<0.001). The multivariate Cox regression analysis showed that the relative risk to develop MACE was 51% lower in the personalized treatment group as compared with the non-personalized treatment group [hazard ratio (HR)=0.49; 95% confidence interval (CI): 0.31-0.77; P<0.001]. Similarly, there was a clear net benefit of the personalized antiplatelet treatment over the non-personalized treatment (ischemic and bleedings events: 8.2% versus 18.7% respectively; HR=0.46; 95%CI: 0.29-0.70; P<0.001). Further analysis indicated that patients with aggregation values within the therapeutic window (21-49 units) experienced the lowest event rates (stent thrombosis and major bleeding: 2.5%) as compared with poor responders (≥50 units: 5.4%) or ultra-responders (0-20 units: 5.2%). In conclusion, personalized antiplatelet treatment might improve patients' outcome without increasing bleeding complications compared with the non-personalized treatment during a 12-month follow-up.
authors.affiliation: *Department of Cardiology, Medical University of Vienna, Austria.
authors.forename: Jolanta M
authors.initials: JM
authors.lastname: Siller-Matula
authors.affiliation: †5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Carina
authors.initials: C
authors.lastname: Gruber
authors.affiliation: †5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Marcel
authors.initials: M
authors.lastname: Francesconi
authors.affiliation: †5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Dechant
authors.affiliation: ‡Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
authors.forename: Bernd
authors.initials: B
authors.lastname: Jilma
authors.affiliation: *Department of Cardiology, Medical University of Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Delle-Karth
authors.affiliation: §Clinical Institute for Laboratory Medicine, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Katharina
authors.initials: K
authors.lastname: Grohs
authors.affiliation: †5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Podczeck-Schweighofer
authors.affiliation: †5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Günter
authors.initials: G
authors.lastname: Christ
mesh_terms: D000368:Aged; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010879:Piperazines / Q000009:adverse effects / Q000494:pharmacology*; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology*; D000068799:Prasugrel Hydrochloride; D057285:Precision Medicine; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000494:pharmacology*; D012044:Regression Analysis; D013876:Thiophenes / Q000009:adverse effects / Q000494:pharmacology*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine