A Nearly 50% Risk of MACCE Cutdown by Personalized Antiplatelet Therapy: The Subgroup Analysis of Hypertension in PATH-PCI Trial

Abstract

Background: Individualized antiplatelet therapy has been gradually chosen by more and more (percutaneous coronary intervention) PCI patients. Hypertension, as an important risk factor for a variety of adverse outcomes after PCI, has been found in many studies. Therefore, we are interested in whether patients who undergo PCI have a different benefit from individualized antiplatelet therapy when they have hypertension. Aims: To evaluate the safety and efficacy of individualized treatment in PCI patients with or without hypertension. Methods: Two thousand two hundred and thirty-seven chronic coronary syndrome patients from PATH-PCI study were randomly assigned to receive either personalized antiplatelet therapy group or standard antiplatelet therapy group. Then sub-analysis were conducted to estimate the results of clinical outcomes after 180 days follow-up between hypertension or non-hypertension across the two treatment groups. Results: Compared with the standard treatment group, patients with hypertension who received individualized treatment had fewer adverse events. The MACCE incidences were (21 [3.3%] vs. 37 [5.8%], p = 0.038), MACE incidences was (14 [2.2%] vs. 28 [4.4%], p = 0.033), ST incidences was (2 [0.3%] vs. 10 [1.6%], p = 0.038), and TVR incidences was (1 [0.2%] vs. 8 [1.2%], p = 0.038). Within patients without hypertensive, after individualized therapy, there were also less NACE (25 [5.1%] vs. 39 [8.3%], p = 0.045), MACCE (14 [2.8%] vs. 33 [7.0%], p = 0.003), MACE (11 [2.2%] vs. 24 [5.1%], p = 0.017), and Re-MI incidences (7 [1.4%] vs. 17 [3.6%], p = 0.029) recorded. After multivariable Cox analyses, individualized treatment had a significant protective effect against MACE (HR = 0.48, 95% CI 0.25−0.92, p = 0.028), MACCE (HR = 0.55, 95% CI 0.32−0.94, p = 0.029), and ST (HR = 0.18, 95% CI 0.04−0.85, p = 0.030) in hypertensive patients. Besides, there were certain protective effects on reducing MACE (HR = 0.43, 95% CI 0.21−0.89, p = 0.023), MACCE (HR = 0.41, 95% CI 0.22−0.77, p = 0.005), and Re-MI (HR = 0.37, 95% CI 0.15−0.91, p = 0.029) incidences in non-hypertensive patients with personalized antiplatelet therapy. Conclusion: Individualized treatment can provided multiple protective effects, which significant decreasing the MACCE and MACE incidences in all CCS patients after PCI without increasing the risk of bleeding compared with standard therapy. Beside, a protective effect against stent thrombosis in hypertension and against Re-MI incidence in non-hypertension were obvious. Trial Registration: The details of the design were registered on http://www.chictr.org.cn (Identifier: ChiCTR-INR-16010077).