A narrow therapeutic window of platelet P2Y12 reactivity in high-risk Chinese percutaneous coronary intervention patients.

BACKGROUND: Much evidence has been provided that a therapeutic window of P2Y12receptor inhibition exists, which is highly significantly associated with ischemic and bleeding events. The therapeutic window for high-risk stratification after percutaneous coronary intervention (PCI) is lacking. We aimed to investigate the therapeutic window of P2Y12receptor inhibition in high-risk Chinese PCI patients.

METHODS: In this observational study, we analyzed 860 high-risk patients who were undergoing PCI. The primary endpoint was the correlation between vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) values with bleeding and ischemic components in high-risk patients. The secondary endpoint was a composite of cardiovascular death, myocardial infarction, definite stent thrombosis, urgent revascularization, and stroke at 12 months after the index procedure.

RESULTS: Among high-risk patients, VASP-PRI could significantly discriminate between PCI patients with and without ischemic events (area under the curve (AUC): 0.77; 95% CI [0.72-0.82]; P < 0.001). A VASP-PRI ≥ 0.45 was the optimal cutoff point to predict ischemic events (sensitivity: 86.6%; specificity: 63.6%). Similarly, VASP-PRI could also significantly discriminate between PCI patients with and without bleeding events ((AUC): 0.77; 95% CI [0.73-0.81]; P < 0.001). A VASP-PRI ≤ 0.24 was the optimal cutoff point to predict bleeding events (sensitivity: 72.1%; specificity: 70.3%). Multivariate analysis showed that VASP-PRI was an independent predictor of the risk of major adverse cardiovascular events (odds ratio: 10.67, 95% CI [3.78-30.08]).

CONCLUSION: Our results suggest that high-risk Chinese PCI patients have a narrow therapeutic window. Within this window, high-risk patients are at lower risk for both ischemic and bleeding events. Platelet reactivity may have significant implications for personalized antiplatelet therapy in high-risk patients.