Feature | November 02, 2012

Low Clopidogrel Responsiveness Predicts Stent Thrombosis, Heart Attack

One-year results of ADAPT-DES presented at TCT 2012

ADAPT-DES study TCT, 2012, Plavix, stent

November 2, 2012 — Patients who receive a drug-eluting stent (DES) and demonstrate low levels of platelet inhibition are more likely to have blood clots form on the stent and suffer a possible heart attack; conversely, patients with higher levels of platelet inhibition are at greater risk for bleeding complications. This is according to one-year results of the ADAPT-DES study, presented the 24th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation.

At last year’s TCT meeting, ADAPT-DES researchers demonstrated a strong relationship between platelet hyporesponsiveness to clopidogrel and subsequent stent thrombosis (clot formation) up to 30 days after stent implantation. Now after one year of follow-up, the ADAPT-DES team is reporting the overall treatment implications of platelet hyporesponsiveness on patient outcomes.

In this large multicenter registry, 8,583 patients undergoing a percutaneous coronary intervention (PCI) with at least one drug-eluting stent were enrolled at 11 sites between January 2008 and September 2010. Researchers assessed platelet reactivity with the VerifyNow Aspirin, P2Y12 and IIb/IIIa tests. Patients were followed for one year to determine the relationship between platelet hyporesponsiveness and subsequent events. At one year, stent thrombosis occurred in 70 patients (0.84 percent), heart attack in 224 (2.7 percent), major bleeding in 531 (6.2 percent) and death in 161 (1.9 percent).

The number of platelet reactivity units (PRU) was measured by the VerifyNow P2Y12 test. Clopidogrel hyporesponsiveness was defined by a PRU of greater than 208 and was present in 42.7 percent of patients. Clopidogrel hyporesponsiveness was significantly associated with stent thrombosis (1.3 percent vs. 0.5 percent) and heart attack (3.9 percent vs. 2.7 percent), but was also found to protect against major bleeding (5.6 percent vs. 6.7 percent). Clopidogrel hyporesponsiveness was also associated with one-year mortality (2.4 percent vs. 1.5 percent). However, because clopidogrel hyporesponsiveness is also associated with other patient risk factors and baseline characteristics, multivariable modeling was also performed, which demonstrated no independent association between clopidogrel hyporesponsiveness and mortality.

“Results from the ADAPT-DES registry suggest that clopidogrel hyporesponsiveness after implantation of a drug-eluting stent is an independent predictor of one-year stent thrombosis and heart attack, but it is also protective against major bleeding, both of which impact mortality,” said lead investigator Gregg W. Stone, M.D., professor of medicine at Columbia University College of Physicians and Surgeons, and director of cardiovascular research and education at the Center for Interventional Vascular Therapy at New York-Presbyterian Hospital/Columbia University Medical Center.

“Clopidogrel hyporesponsiveness was not found to be an independent predictor of one-year mortality. Therefore, overcoming clopidogrel hyporesponsiveness with more potent antiplatelet agents is unlikely to improve survival unless the beneficial effect of reducing stent thrombosis and heart attack can be separated from the likely increase in bleeding that results from greater platelet inhibition,” said Stone.

He added, “Hyporesponsiveness to aspirin was unrelated to stent thrombosis, heart attack or death, but may be related to bleeding. This questions the utility of aspirin in patients treated with drug-eluting stents.”

The ADAPT-DES trial was sponsored by the Cardiovascular Research Foundation with research support from Boston Scientific, Abbott Vascular, Medtronic, Cordis, Biosensors, The Medicines Company, Daiichi Sankyo, Eli Lilly, Volcano and Accumetrics. Stone reported consulting fees from Abbott Vascular, Boston Scientific, Medtronic, The Medicines Company, Daiichi Sankyo, Eli Lilly, Astra Zeneca and Volcano.

For more information: www.crf.org

Related Content

Interventional cardiology, cath lab technology, TCT, transcatheter cardiovascular therapeutics
Feature | Cath Lab| October 27, 2016 | Dave Fornell
The volume of information attendees receive at the annual Transcatheter Cardiovascular Therapeutics (TCT) interventio
Philips, TCT 2016, image guidance technologies, iFR, HeartNavigator
News | Cath Lab| October 26, 2016
Philips recently announced its latest image guidance solutions to be featured at the 2016 Transcatheter Cardiovascular...
Medtronic, CoreValve Evolut R, TAVR system, 34 mm valve, FDA approval, largest in the U.S.
Technology | Heart Valve Technology| October 26, 2016
Medtronic announced the U.S. Food and Drug Administration (FDA) approval and U.S. launch of the CoreValve Evolut R 34...
UAB, University of Alabama at Birmingham study, stroke prevention, non-valvular atrial fibrillation, NVAF
News | Atrial Fibrillation| October 25, 2016
A recent study from University of Alabama at Birmingham (UAB) researchers published in PLOS ONE compares different...
pediatric echocardiograms, cardiovascular ultrasound, therapy dog impact, animal-assisted therapy, Human Animal Bond Research Initiative, HABRI
News | Cardiovascular Ultrasound| October 25, 2016
The Human Animal Bond Research Initiative (HABRI) announced it has awarded a $44,000 grant to Duke University School of...
medicare bundled cardiac payments, CMS cardiology payments
Feature | Business| October 24, 2016 | By John W. Meyer, MPH, FACHE
(Editor’s note: This is the second part of a two-part series on the proposed Medicare five-year demonstration for
bioresorbable stents, bioabsorbable stents, visualizing the Absorb BVS, dissolving stent, disappearing stent on IVUS and OCT

A comparison of how the Abbott Absorb BVS appears with intravascular ultrasound (IVUS) on the left, and optical coherence tomography (OCT) of the right. The stent is difficult to visualize and sizing is critical, so both modalities can help in bioresorbable stent measurements and to confirm stent apposition. Left image from the Volcano IVUS system and the right image from St. Jude Medical's OCT system


Feature | Stents Bioresorbable| October 20, 2016 | Dave Fornell
There has been a lot of interest in the interventional community regarding the Abbott Absorb Bioresorbable Vascular S
Avinger, Pantheris atherectomy catheter, OCT, Lumivascular technology, expanded FDA indication, diagnostic imaging device
News | Atherectomy Devices| October 20, 2016
Avinger Inc. recently announced that the company has received expanded indications from the U.S. Food and Drug...
St. Jude Medical, ADO II AS trial, congenital heart disease, PDA, Amplatzer Duct Occluder II AS
News | Congenital Heart| October 19, 2016
St. Jude Medical Inc. announced the launch of the ADO II AS (AMPLATZER Duct Occluder II Additional Sizes) pediatric...
Overlay Init