Relationship Between Platelet Aggregation and Clinical Events After Percutaneous Coronary Intervention for Dialysis Patients　― A PENDULUM Analysis Substudy ―

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Background: Patients with endstage kidney disease undergoing hemodialysis (HD) have higher risks of ischemic and bleeding events after percutaneous coronary intervention (PCI). However, the association between high platelet reactivity (HPR) and clinical events in dialysis patients remains unclear. This post hoc analysis of the PENDULUM registry examined the relationships of HPR with major adverse cardiac and cerebrovascular events (MACCE) and major bleeding in dialysis patients.

Methods and Results: Based on P2Y₁₂reaction unit (PRU) levels, patients were stratified into HPR (PRU >208) and non-HPR (PRU ≤208) groups. Clinical events were assessed up to 30 months after the index PCI. A total of 6,266 patients were enrolled. Of the 5,907 patients with available PRU data, 357 were dialysis patients (HPR, n=199; Non-HPR, n=158), and 5,550 were non-dialysis patients (HPR, n=2,030; Non-HPR, n=3,520). Dialysis patients had significantly more frequent MACCE and major bleeding than non-dialysis patients. In non-dialysis patients, MACCE, but not bleeding events, were significantly more common in the HPR subgroup. However, in dialysis patients, no significant association was found between HPR and both MACCE and major bleeding.

Conclusions: HPR was not associated with increased risks of MACCE and major bleeding in dialysis patients.