Is There an Ideal Level of Platelet XXXX -Receptor Inhibition in @entity1  Undergoing Percutaneous Coronary Intervention?: "Window" Analysis From the ADAPT-DES Study (Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents).

@entity1 @entity548 @entity63 @entity1397 @entity715 @entity3075
OBJECTIVES: This study sought to determine whether there is an ideal level of platelet reactivity (PR) to optimize safety and efficacy within the large multicenter ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents) study of 8,582 @entity1 receiving successful drug-eluting stent implantation. BACKGROUND: @entity1 with high PR on @entity1397 have a greater incidence of adverse ischemic events after stent implantation, whereas low PR may increase @entity548 . Due to limited sample size, previous studies have not been able to adjust for differences in baseline characteristics that may confound the relationship of PR and outcomes. METHODS: In the ADAPT-DES study, routine platelet function testing (VerifyNow) was performed following @entity1397 loading. To characterize the independent association between PR and clinical events, @entity1 were stratified into quintiles of @entity3075 reaction units (PRU). RESULTS: The PRU medians of the 5 quintiles were 57, 130, 187, 244, and 317 (most to least inhibited). There was a monotonic association between successively higher PRU quintiles and stent @entity715 , whereas for clinically relevant @entity548 , the greatest risk occurred in the lowest PRU quintile, with similar risks across the 4 higher quintiles. These relationships remained significant in fully adjusted multivariable analyses (adjusted hazard ratio [HR] for stent @entity715 in Q5 versus Q1: 2.32; 95% confidence interval [CI]: 1.17 to 4.59; p  = 0.02; adjusted HR for clinically relevant @entity548 in Q5 versus Q1: 0.61; 95% CI: 0.47 to 0.77; p  < 0.001). However, there were no significant independent associations between the level of PRU and mortality. CONCLUSIONS: In this large observational study, increasing PRU was associated with a monotonic increase in stent @entity715 , whereas @entity548 risk was confined to the lowest PRU quintile, suggesting an optimal therapeutic window of platelet inhibition at moderately inhibited PRU. However, there was no demonstrable threshold effect for PRU and mortality in adjusted analyses, perhaps due to the offsetting impact of @entity548 and @entity63 across the spectrum of platelet inhibition. (Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents [ADAPT-DES]; NCT00638794).
