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

Societies Issue New Performance and Quality Measures for Treating Patients with Heart Attack
News | Cath Lab| October 17, 2017
The American College of Cardiology and the American Heart Association recently released updated clinical performance...
First Patient Enrolled in U.S. Arm of ALIVE Pivotal Heart Failure Trial
News | Heart Failure| October 17, 2017
October 17, 2017 — BioVentrix Inc. recently announced enrollment of the first patient in the U.S.
Dee Dee Wang runs Henry Ford Hospital's 3D printing lab for its complex structural heart cardiology program.

Dee Dee Wang, M.D., runs Henry Ford Hospital's 3-D printing lab that supports its complex structural heart program.

Feature | 3-D Printing| October 13, 2017 | Dave Fornell
Three-dimensional (3-D) printed anatomic models created from a patient’s computed tomography (CT), magnetic resonance...
Low Mortality and Stroke Risks Displayed for Minimally Invasive Aortic Valve Replacements
News | Heart Valve Technology| October 11, 2017
An analysis of more than 1,000 minimally invasive aortic valve replacements and more than 400 additional associated...
New Evaluation Sends Low-Risk ER Chest Pain Patients Home Sooner
News | Cardiac Diagnostics| October 10, 2017
A new evaluation to determine whether emergency room patients with chest pain can go home and follow up with their...
Videos | Chronic Total Occlusion (CTO)| October 09, 2017
Bill Lombardi, M.D., director of complex coronary artery interventions at the University of Washington, discusses the
BTG Acquires Roxwood Medical
News | Business| October 05, 2017
BTG plc announced it has acquired Roxwood Medical, provider of advanced cardiovascular specialty catheters used in the...
TVA Medical Receives CE Mark for Next-Generation EverlinQ 4 EndoAVF System
News | Vascular Access| October 04, 2017
TVA Medical Inc. announced that its everlinQ 4 endoAVF System has received CE Mark in the European Union. The...
News | Pharmaceuticals| October 04, 2017
October 4, 2017 — MyoKardia Inc.
Reflow Medical's Wingman Crossing Catheter Receives FDA Clearance for Coronary Indication
News | Catheters| October 02, 2017
October 2, 2017 — Reflow Medical Inc. announced that the company has received 510(k) clearance from the U.S.
Overlay Init