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Impact of Chronic Kidney Disease and Platelet Reactivity on Clinical Outcomes Following Percutaneous Coronary Intervention

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Abstract

We investigated the interaction between chronic kidney disease (CKD) and high platelet reactivity (HPR) in determining long-term clinical outcomes following elective PCI for stable coronary artery disease (CAD). A total of 500 patients treated with aspirin and clopidogrel were divided based on the presence of CKD (defined as glomerular filtration rate of < 60 ml/min/1.73 m2) and HPR (defined as a P2Y12 reaction unit value ≥ 240 at VerifyNow assay). Primary endpoint was the occurrence of major adverse clinical events (MACE) at 5 years. Patients with both CKD and HPR showed the highest estimates of MACE (25.6%, p = 0.005), all-cause death (17.9%, p = 0.004), and cardiac death (7.7%, p = 0.004). The combination of CKD and HPR was an independent predictor of MACE (HR 3.12, 95% CI 1.46–6.68, p = 0.003). In conclusion, the combination of CKD and HPR identifies a cohort of patients with the highest risk of MACE at 5 years.

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Authors and Affiliations

  1. Unit of Cardiovascular Science, Department of Medicine, Campus Bio-Medico University, Rome, Italy

    Fabio Mangiacapra, Alessandro Sticchi, Edoardo Bressi, Michele Mattia Viscusi, Iginio Colaiori, Elisabetta Ricottini, Ilaria Cavallari, Gian Paolo Ussia & Francesco Grigioni

  2. U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia

    Roberto Mangiacapra & Pietro Manuel Ferraro

  3. Università Cattolica del Sacro Cuore, Roma, Italia

    Roberto Mangiacapra & Pietro Manuel Ferraro

  4. Unit of Diagnostic and Therapeutic Medicine, Department of Medicine, Campus Bio-Medico University, Rome, Italy

    Silvia Spoto

Authors
  1. Fabio Mangiacapra
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  2. Alessandro Sticchi
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  4. Roberto Mangiacapra
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  12. Francesco Grigioni
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Fabio Mangiacapra, Alessandro Sticchi, Edoardo Bressi, Michele Mattia Viscusi, Iginio Colaiori, Elisabetta Ricottini, and Ilaria Cavallari. The first draft of the manuscript was written by Fabio Mangiacapra and Alessandro Sticchi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fabio Mangiacapra.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Associate Editor Angela Taylor oversaw the review of this article

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Mangiacapra, F., Sticchi, A., Bressi, E. et al. Impact of Chronic Kidney Disease and Platelet Reactivity on Clinical Outcomes Following Percutaneous Coronary Intervention. J. of Cardiovasc. Trans. Res. 14, 1085–1092 (2021). https://doi.org/10.1007/s12265-021-10126-8

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  • DOI: https://doi.org/10.1007/s12265-021-10126-8

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