Long-term outcome of tailored antithrombotic therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a 5-year retrospective cohort study.

Abstract

Dual antiplatelet therapy is the standard therapy for the secondary prevention of acute and chronic coronary syndromes in patients undergoing percutaneous coronary intervention (PCI). The introduction of more potent antiplatelet agents and understanding of prognostic implications associated with bleeding have led to a substantial evolution in antiplatelet treatment regimens over the past decades. Several investigations have been conducted to better stratify patients undergoing PCI according to their ischemic and bleeding risks and to optimize antithrombotic regimens accordingly. One of the available strategies involves using platelet aggregation tests to determine the most suitable antiplatelet agent to combine with aspirin. Our aim was to evaluate the role of platelet function tests (PFT) in clinical practice in choosing dual antiplatelet therapy for patients undergoing PCI: in this study, we compared the impact on ischemic and hemorrhagic cardiovascular events in a 5 year follow-up between patients treated according to standard guidelines and those treated with a platelet function test guided approach. This study included 490 patients with acute or chronic coronary syndrome who underwent percutaneous angioplasty between 2013 and 2016 and were subsequently treated with dual antiplatelet therapy. Patients whose treatment strategy was based on PFT were 68.4% (n = 335), while others received standard therapy. The primary endpoint of the study was to assess the incidence of net adverse clinical events (NACE), defined as a composite of all-cause mortality, myocardial infarction, stroke, or major bleeding, according to the BARC scale. Follow-up was conducted 5 years after angioplasty by telephone contact or by consulting patients' medical records. Heart failure and stable angina were considered as secondary endpoints. From the univariate analysis, the incidence of NACE was significantly lower in patients who received tailored therapy (33.7% vs. 43.9% in the non-tailored group, p = 0.02). In addition, results showed that total length of implanted stents and left main coronary disease were independent risk factors for net adverse clinical events (NACE). Similarly, an initial diagnosis of N-STEMI or unstable angina was associated with an increased risk of adverse events during follow-up. In patients undergoing PCI, a tailored antithrombotic approach guided by PFT appears safe and effective, may represent a feasible strategy in contemporary practice and should be considered in case of high bleeding risk.