title: Individualising dual antiplatelet therapy after percutaneous coronary intervention: the IDEAL-PCI registry.
abstract: OBJECTIVE
  To evaluate the clinical utility of individualising dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in an all-comers population, including ST-elevation myocardial infarction (STEMI) patients.
  
  
  METHODS
  Tertiary care single centre registry.
  
  
  METHODS
  1008 consecutive PCI patients with stent implantation, without exclusion criteria.
  
  
  METHODS
  Peri-interventional individualisation of DAPT, guided by multiple electrode aggregometry (MEA), to overcome high on-treatment platelet reactivity (HPR) to ADP-induced (≥50 U) and arachidonic acid (AA)-induced aggregation (>35 U).
  
  
  METHODS
  The primary efficacy end point was definite stent thrombosis (ST) at 30 days. The primary safety end point was thrombolysis in myocardial infarction (TIMI) major and minor bleeding. Secondary end points were probable ST, myocardial infarction, cardiovascular death and the combined end point: major cardiac adverse event (MACE).
  
  
  RESULTS
  53% of patients presented with acute coronary syndrome (9% STEMI, 44% non-ST-elevation). HPR to ADP after 600 mg clopidogrel loading occurred in 30% of patients (73±19 U vs 28±11 U; p<0.001) and was treated by prasugrel or ticagrelor (73%), or clopidogrel (27%) reloading (22±12 U; p<0.001). HPR to ADP after prasugrel loading occurred in 2% of patients (82±26 U vs 19±10 U; p<0.001) and was treated with ticagrelor (34±15 U; p=0.02). HPR to AA occurred in 9% of patients with a significant higher proportion in patients with HPR to ADP (22% vs 4%, p<0.001) and was treated with aspirin reloading. Definite ST occurred in 0.09% of patients (n=1); probable ST, myocardial infarction, cardiovascular death and MACE occurred in 0.19% (n=2), 0.09% (n=1) and 1.8% (n=18) of patients. TIMI major and minor bleeding did not differ between patients without HPR and individualised patients (2.6% for both).
  
  
  CONCLUSIONS
  Individualisation of DAPT with MEA minimises early thrombotic events in an all-comers PCI population to an unreported degree without increasing bleeding. A randomised multicentre trial utilising MEA seems warranted.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov; NCT01515345.
authors.affiliation: 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Günter
authors.initials: G
authors.lastname: Christ
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Jolanta M
authors.initials: JM
authors.lastname: Siller-Matula
authors.affiliation: 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Marcel
authors.initials: M
authors.lastname: Francesconi
authors.affiliation: 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Dechant
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 with Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Podczeck-Schweighofer
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000628:therapy*; D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001241:Aspirin / Q000627:therapeutic use; D001792:Blood Platelets; D000077144:Clopidogrel; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010879:Piperazines / Q000627:therapeutic use; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride; D057285:Precision Medicine / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D013876:Thiophenes / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; D001241:Aspirin