ADAPT-DES: Stent Thrombosis Increased During First 30 Days After PCI in High-Risk Patients

Patients with ACS experience more early stent thrombosis than do stable patients, according to results that will be presented Sunday at TCT 2014.

Using broad inclusion criteria, Ajay J. Kirtane, MD, SM, of Columbia University Medical Center in New York, and colleagues prospectively enrolled 8,582 patients undergoing PCI with drug-eluting stents (DES). There were 2,063 patients with MI, 2,370 with unstable angina alone and 4,149 without ACS.

Platelet function was assessed with the VerifyNow assay (Accumetrics). Patients with MI had a mean platelet reactivity unit (PRU) count of 199, compared with 189 for those with unstable angina and 182 for those without ACS (P<.0001 for trend). Similarly, high platelet reactivity — defined as PRU >208 — occurred in 48% of the MI group, 43.3% of the unstable angina group and 39.8% of the non-ACS group.

Two-year definite or probable stent thrombosis rates were 1.75% for MI, 1.13% for unstable angina and 0.80% for non-ACS patients (P=.003), but the increased incremental risk for stent thrombosis in both of the ACS groups occurred early after the procedure and not beyond 30 days (see Table).

 “This emphasizes that we should treat patients with potent antiplatelet therapy up front and early,” Kirtane told TCT Daily. “Clinically, this is relevant because there may be patients for whom this therapy is too expensive. Maybe in the long run — although it hasn’t been shown prospectively yet — the first 30 days will be shown to be the most important period.”