Effects of high platelet reactivity after percutaneous coronary intervention

This study investigated the effect of high platelet reactivity (HPR) on major adverse cardiac events (MACEs) in people who have undergone percutaneous coronary intervention (PCI). It was determined that people with HPR were more likely to have a MACE.

PCI (or angioplasty) is a non-surgical procedure where narrow or blocked arteries are widened or unblocked. A balloon is inflated inside the artery to open it. In some cases a stent is also implanted. A stent is a flexible tube that helps to keep the artery open. Drug-eluting stents also release medication into the body. Drug-eluting balloons are a newer treatment that can be used instead of drug-eluting stents. They also release drugs into the body. These drugs prevent cells from gathering inside the stent and blocking it again.

Platelets are small cells that can produce blood clots, which block arteries. Patients who undergo PCI are treated with drugs that stop platelets from doing this. HPR refers to high platelet activity in patients who are taking anti-platelet drugs. It is not clear how HPR affects patients after PCI with drug-eluting balloons.

194 people with stable angina (severe chest pain that occurs during activities like exercising) were recruited for this study. They had been treated with PCI using drug-eluting balloons. They all received two anti-platelet drugs. They were followed up for an average of 1 year. Any MACEs that occurred were noted. MACEs include death due to cardiovascular causes, heart attacks, strokes, or revascularization. Revascularization is a second, unplanned PCI or surgery to unblock an artery, in the same artery as the first procedure, or in another blood vessel in the heart.

27 patients experienced at least one MACE during the follow-up period. One died due to cardiovascular causes and 12 had a heart attack. 26 needed revascularization. No strokes were reported during the study.

152 patients were tested for HPR. 21% had HPR. Patients with HPR were 2.45 times more likely to experience a MACE than those without HPR. They were particularly more likely to have a heart attack or need revascularization.

Patients with longer drug-eluting balloons were 4% more likely to experience a MACE. Patients who had been treated with statins (drugs that lower cholesterol) were 72% less likely to experience a MACE.

The study concluded that HPR was associated with an increased risk of MACE in patients with stable angina who underwent PCI with drug-eluting balloons. The length of the balloon and whether the patient had taken statins also affected the likelihood of MACE.

This study examined only a small number of people. The results may not apply to all people with coronary artery disease.

Discuss the impact of platelet function on MACE with your physician.