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RELATIONSHIP BETWEEN VESSEL SIZE, PLATELET REACTIVITY, AND STENT THROMBOSIS AFTER DRUG-ELUTING STENT PERCUTANEOUS CORONARY ARTERY INTERVENTION
324 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology RELATIONSHIP BETWEEN VESSEL SIZE, PLATELET REACTIVITY, AND STENT THROMBOSIS AFTER DRUG-ELUTING STENT PERCUTANEOUS CORONARY ARTERY INTERVENTION Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Angiography and Interventional CT/MR Abstract Category: 2. ACC.i2 Interventional Cardiology: Angiography and Interventional CT/MR Presentation Number: 1224-159 Authors: Bjorn Redfors, Rushad K. Dordi, Tullio Palmerini, Gennaro Giustino, Girma Ayele, Adriano Caixeta, Ajay Kirtane, Roxana Mehran, Gregg Stone, Philippe Genereux, Cardiovascular Research Foundation, New York, NY, USA, Columbia University Medical Center, New York, NY, USA
Background: Few studies have addressed the importance of reference vessel diameter (RVD) for the risk of stent thrombosis (ST) after PCI with drug-eluting stents (DES). Those that did typically modeled RVD as a dichotomized or categorical variable. This is associated with considerable loss of information and increases the risk of type II statistical errors. The aim of this study was to determine the relationship between RVD and the risks of ST and cardiac death.
Methods: We modeled RVD as a continuous predictor of ST risk in uni- and multivariate Cox proportional hazards models using data on 8582 patients in the ADAPT-DES registry. We determined the relationship between RVD and ST risk by estimating the cubic spline function for a Cox proportional hazards model. We also tested whether the effect of RVD was moderated by high platelet reactivity. We validated the relationship between RVD and ST observed in the ADAPT-DES data by estimating the same model using data from 3602 patients in the HORIZONS-AMI trial. Results: We found a U-shaped relationship between RVD and ST risk (p<0.035). This relationship was only observed when platelet reactivity was low (pinteraction<0.027) and was paralleled by a non-significant relationship with risk of cardiac death (p=0.139). These findings were consistent in univariate and multivariate analyses.
Conclusions: DES PCI of a vessel with a smaller RVD is associated with increased risk of ST. This may translate to a considerable risk of cardiac death.
ACC.i2 Interventional Cardiology RELATIONSHIP BETWEEN VESSEL SIZE, PLATELET REACTIVITY, AND STENT THROMBOSIS AFTER DRUG-ELUTING STENT PERCUTANEOUS CORONARY ARTERY INTERVENTION Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: ACC.i2 Interventional Cardiology: Angiography and Interventional CT/MR Abstract Category: 2. ACC.i2 Interventional Cardiology: Angiography and Interventional CT/MR Presentation Number: 1224-159 Authors: Bjorn Redfors, Rushad K. Dordi, Tullio Palmerini, Gennaro Giustino, Girma Ayele, Adriano Caixeta, Ajay Kirtane, Roxana Mehran, Gregg Stone, Philippe Genereux, Cardiovascular Research Foundation, New York, NY, USA, Columbia University Medical Center, New York, NY, USA
Background: Few studies have addressed the importance of reference vessel diameter (RVD) for the risk of stent thrombosis (ST) after PCI with drug-eluting stents (DES). Those that did typically modeled RVD as a dichotomized or categorical variable. This is associated with considerable loss of information and increases the risk of type II statistical errors. The aim of this study was to determine the relationship between RVD and the risks of ST and cardiac death.
Methods: We modeled RVD as a continuous predictor of ST risk in uni- and multivariate Cox proportional hazards models using data on 8582 patients in the ADAPT-DES registry. We determined the relationship between RVD and ST risk by estimating the cubic spline function for a Cox proportional hazards model. We also tested whether the effect of RVD was moderated by high platelet reactivity. We validated the relationship between RVD and ST observed in the ADAPT-DES data by estimating the same model using data from 3602 patients in the HORIZONS-AMI trial. Results: We found a U-shaped relationship between RVD and ST risk (p<0.035). This relationship was only observed when platelet reactivity was low (pinteraction<0.027) and was paralleled by a non-significant relationship with risk of cardiac death (p=0.139). These findings were consistent in univariate and multivariate analyses.
Conclusions: DES PCI of a vessel with a smaller RVD is associated with increased risk of ST. This may translate to a considerable risk of cardiac death.