JACC: Cardiovascular Interventions
Focus on Antiplatelet Therapy
The Impact of Timing of Ischemic and Hemorrhagic Events on Mortality After Percutaneous Coronary InterventionThe ADAPT-DES Study
Sorin J. Brener, Ajay J. Kirtane, Thomas D. Stuckey, Bernhard Witzenbichler, Michael J. Rinaldi, Franz-Josef Neumann, D. Christopher Metzger, Timothy D. Henry, David A. Cox, Peter L. Duffy, Ernest L. Mazzaferri Jr., Roxana Mehran, Rupa Parvataneni, Bruce R. Brodie and Gregg W. Stone
Table 1
Table 1
Baseline and Procedural Characteristics of Patients With and Without Events
| MI (n = 294) | ST (n = 75) | CB (n = 691) | No MI, ST, or CB (n = 7,522) | p Value | |
|---|---|---|---|---|---|
| Age, yrs | 64.6 ± 11.2 (294) | 62.1 ± 12.0 (75) | 66.9 ± 10.5 (691) | 63.3 ± 10.8 (7,522) | <0.0001 |
| Male | 73.8% (217/294) | 72.0% (54/75) | 68.9% (476/691) | 74.6% (5,610/7,522) | 0.10 |
| Diabetes | 44.2% (130/294) | 48.0% (36/75) | 33.7% (233/691) | 31.7% (2,384/7,522) | <0.0001 |
| Insulin treated | 22.4% (66/294) | 20.0% (15/75) | 13.3% (92/691) | 11.0% (825/7,522) | <0.0001 |
| History of peripheral arterial disease | 19.0% (56/294) | 18.7% (14/75) | 14.3% (99/691) | 9.4% (707/7,522) | <0.0001 |
| History of congestive heart failure | 13.9% (41/294) | 5.3% (4/75) | 12.3% (85/691) | 7.6% (569/7,522) | <0.0001 |
| Previous MI | 33.7% (99/294) | 38.7% (29/75) | 26.2% (181/691) | 24.7% (1,855/7,522) | 0.0002 |
| Previous CABG | 28.9% (85/294) | 20.0% (15/75) | 18.2% (126/691) | 16.5% (1,242/7,522) | <0.0001 |
| Previous PCI | 50.7% (149/294) | 53.3% (40/75) | 46.3% (320/691) | 42.1% (3,169/7,522) | 0.001 |
| History of dialysis | 3.1% (9/294) | 5.3% (4/75) | 3.0% (21/691) | 1.4% (104/7,522) | <0.0001 |
| Hypertension | 84.7% (249/294) | 86.7% (65/75) | 86.0% (594/691) | 78.8% (5,925/7,522) | <0.0001 |
| Hyperlipidemia | 79.9% (235/294) | 74.7% (56/75) | 79.6% (550/691) | 73.6% (5,539/7,522) | 0.0008 |
| Cigarette smoking | 55.4% (163/294) | 68.0% (51/75) | 54.1% (374/691) | 56.4% (4,241/7,522) | 0.13 |
| Current (within 1 month) | 21.4% (63/294) | 32.0% (24/75) | 20.0% (138/691) | 22.8% (1,715/7,522) | 0.08 |
| Acute coronary syndrome | 59.5% (175/294) | 64.0% (48/75) | 42.7% (295/691) | 52.0% (3,915/7,522) | <0.0001 |
| Unstable angina | 31.6% (93/294) | 28.0% (21/75) | 22.7% (157/691) | 27.9% (2,099/7,522) | 0.02 |
| Non–ST-segment elevation | 23.1% (68/294) | 17.3% (13/75) | 14.2% (98/691) | 14.2% (1,070/7,522) | 0.0003 |
| ST-segment elevation | 4.8% (14/294) | 18.7% (14/75) | 5.8% (40/691) | 9.9% (746/7,522) | <0.0001 |
| Killip class II–IV at time of PCI | 2.7% (8/294) | 0.0% (0/75) | 2.6% (18/691) | 2.1% (155/7,522) | 0.38 |
| Anemia | 29.3% (86/294) | 25.3% (19/75) | 29.4% (203/691) | 20.9% (1,564/7,486) | <0.0001 |
| Creatinine clearance <60 ml/min | 24.0% (70/292) | 20.0% (15/75) | 25.9% (179/690) | 15.2% (1,138/7,486) | <0.0001 |
| Degree of coronary artery disease | |||||
| 1 vessel | 21.8% (64/294) | 32.0% (24/75) | 30.5% (211/691) | 39.7% (2,984/7,522) | <0.0001 |
| 2 vessels | 36.4% (107/294) | 36.0% (27/75) | 32.9% (227/691) | 32.9% (2,474/7,522) | 0.60 |
| 3 vessels | 41.8% (123/294) | 32.0% (24/75) | 36.6% (253/691) | 27.4% (2,064/7,522) | <0.0001 |
| Left main >50% stenosis | 3.7% (11/294) | 2.7% (2/75) | 5.2% (36/691) | 2.8% (208/7,522) | 0.004 |
| Ejection fraction <40% | 35.7% (105/294) | 38.7% (29/75) | 46.0% (318/691) | 28.2% (2,124/7,522) | <0.0001 |
| Radial access | 7.1% (21/294) | 6.7% (5/75) | 2.5% (17/691) | 4.4% (332/7,522) | 0.06 |
| Vessels treated per patient | 1.29 ± 0.54 (294) | 1.16 ± 0.40 (75) | 1.26 ± 0.52 (691) | 1.17 ± 0.41 (7,522) | <0.0001 |
| Lesions treated per patient | 1.69 ± 1.01 (294) | 1.47 ± 0.78 (75) | 1.60 ± 0.86 (691) | 1.49 ± 0.77 (7,522) | <0.0001 |
| Stents implanted per patient | 2.02 ± 1.32 (294) | 1.84 ± 1.21 (75) | 1.92 ± 1.14 (691) | 1.69 ± 0.99 (7,522) | <0.0001 |
| XIENCE/Promus | 67.7% (199/294) | 49.3% (37/75) | 59.2% (409/691) | 65.0% (4,893/7,522) | 0.0004 |
| Total stent length, mm | 39.5 ± 28.2 (294) | 36.4 ± 25.6 (75) | 36.4 ± 25.0 (691) | 31.8 ± 21.7 (7,522) | <0.0001 |
| Any GPI during index PCI | 4.1% (12/294) | 10.7% (8/75) | 3.6% (25/691) | 3.1% (231/7,522) | 0.002 |
| Time to VerifyNow from PCI, h | 19.11 (16.50–22.40) | 18.58 (15.58–23.30) | 19.73 (17.10–22.38) | 18.90 (16.20–21.67) | <0.0001 |
| ARU | 400 (390–433) | 404 (390–426) | 399 (387–426) | 401 (388–424) | 0.48 |
| ≥550 ARU | 5.2% (15/291) | 5.3% (4/75) | 5.2% (36/686) | 5.7% (423/7,474) | 0.95 |
| PRU | 215 (125–285) | 233 (158–299) | 173 (92–250) | 187.50 (115–260) | <0.0001 |
| >208 PRU | 52.4% (151/288) | 61.3% (46/75) | 38.9% (262/673) | 42.5% (3,150/7,412) | <0.0001 |
| Both ≥550 ARU and >208 PRU | 1.8% (5/285) | 5.3% (4/75) | 2.4% (16/668) | 2.5% (188/7,373) | 0.37 |
| No aspirin at discharge | 0.3% (1/292) | 1.4% (1/73) | 1.0% (7/689) | 0.8% (59/7,522) | 0.68 |
| Daily aspirin without discontinuation for 2 yrs | 78.6% (231/294) | 77.3% (58/75) | 60.6% (419/691) | 82.4% (6,200/7,522) | <0.0001 |
| No clopidogrel at discharge | 0.3% (1/292) | 0.0% (0/73) | 1.2% (8/689) | 0.2% (17/7,522) | 0.0003 |
| Daily clopidogrel without discontinuation for 1 yr | 70.4% (207/294) | 65.3% (49/75) | 55.0% (380/691) | 77.8% (5,854/7,522) | <0.0001 |
| Daily clopidogrel without discontinuation for 2 yrs | 50.7% (149/294) | 44.0% (33/75) | 25.9% (179/691) | 51.2% (3,855/7,522) | <0.0001 |
Values are mean ± SD (N), % (n/N), or median (interquartile range). Patients were analyzed according to first event.
ARU = aspirin reaction units; CABG = coronary artery bypass grafting; CB = clinically relevant bleeding; GPI = glycoprotein IIb/IIIa receptor inhibitor; MI = myocardial infarction; PCI = percutaneous coronary intervention; PRU = P2Y12 reaction units; ST = stent thrombosis.
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