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ADAPT-DES: Platelet responsiveness predicted stent thrombosis
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TCT 2011
Agents that effectively inhibit adenosine diphosphate-induced platelet activation should reduce 30-day stent thrombosis when applied to large patient populations, but they are unlikely to provide useful information to guide clinical decision-making in most patients, data presented at the 2011 Transcatheter Cardiovascular Therapeutics scientific symposium suggest.
Researchers enrolled 8,575 patients undergoing percutaneous coronary intervention with drug-eluting stents in the ADAPT-DES registry from January 2008 to September 2010. After successful implantation of drug-eluting stents, researchers assessed overall platelet responsiveness and platelet reactivity to aspirin and clopidogrel (Plavix, Sanofi-Aventis) with the VerifyNow aspirin, P2Y12 and glycoprotein IIb/IIIa inhibitor tests (Accumetrics).
After 30 days, definite/probable stent thrombosis occurred in 0.46% of patients (n=39). VerifyNow P2Y12 tests assessed absolute and relative levels of platelet inhibition in response to adenosine diphosphate (ADP) antagonists and were powerful independent predictors of stent thrombosis at 30 days. A significant proportion of these events were independently attributed to clopidogrel hyporesponsiveness. However, baseline levels of platelet P2Y12, aspirin and overall platelet responsiveness after dual antiplatelet therapy loading were not related to stent thrombosis at 30 days.
In diabetic and nondiabetic patients and those with ACS, platelet responsiveness to ADP antagonist loading predicted 30-day stent thrombosis, according to researchers. However, platelet responsiveness to ADP antagonist loading may have less clinical utility in patients with stable CAD.
“There was a low stent thrombosis rate in patients with stable CAD, which, coupled with the poor prognostic utility of platelet function testing in this setting, suggests that assessing dual antiplatelet therapy response in patients without [ACS] undergoing PCI is unlikely to provide incremental clinical utility,” Gregg W. Stone, MD, director of Cardiovascular Research and Education at New York-Presbyterian Hospital/Columbia University Medical Center and professor of medicine in the division of cardiology at Columbia University College of Physicians and Surgeons, said in a press release. “The relationship between platelet responsiveness testing and the occurrence of late and very late stent thrombosis in patients who have maintained and discontinued dual antiplatelet therapy will be assessed during the 2-year clinical follow-up phase of the ADAPT-DES study.”
Disclosure: The ADAPT-DES trial is sponsored by the Cardiovascular Research Foundation with research support from Abbott Vascular, Accumetrics, Biosensors, Boston Scientific, Cordis, Daiichi Sankyo, Eli Lilly, Medtronic, The Medicines Company and Volcano. Dr. Stone reported consulting fees/honoraria from Abbott Vascular, Boston Scientific, Daiichi Sankyo, Eli Lilly, Medtronic, The Medicines Company and Volcano.
For more information:
- Stone GW. Plenary session V. Late-breaking clinical trials and first report investigations I. Presented at: the 2011 Transcatheter Cardiovascular Therapeutics Scientific Symposium; Nov. 7-11; San Francisco.
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