• Donghoon Han, Sun-Hwa Kim, Dong Geum Shin, Min-Kyung Kang, Seonghoon Choi, Namho Lee, Byeong-Keuk Kim, Hyung Joon Joo, Kiyuk Chang, Yongwhi Park, Young Bin Song, Sung Gyun Ahn, Jung-Won Suh, Sang Yeub Lee, Ae-Young Her, Young-Hoon Jeong, Hyo-Soo Kim, KimMoo HyunMH0000-0003-3468-6453Department of Cardiology, Dong-A University Hospital, Busan, Korea., Do-Sun Lim, Eun-Seok Shin, Jung Rae Cho, and PTRG Investigator.
• Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
• J. Korean Med. Sci. 2024 Jan 22; 39 (3): e27e27.

BackgroundCoronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated.MethodsFrom the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3-5.ResultsA total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85-2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39-2.78). The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group, P < 0.01, 95% CI 2.51-3.91). The frequency of major bleeding was not associated with the HPR in either group.ConclusionLV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry.Trial RegistrationClinicalTrials.gov Identifier: NCT04734028.© 2024 The Korean Academy of Medical Sciences.

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