Smoking And Outcomes Following Personalized Antiplatelet Therapy In Chronic Coronary Syndrome Patients:A Substudy From The Randomized PATH-PCI Trial

Objective: The aim of this study was to explore whether different smoking statuses had an effect on the efficacy and safety of personalized antiplatelet therapy(PAT)in chronic coronary syndrome(CCS)patients undergoing percutaneous coronary intervention(PCI).Methods: As a single-centre,prospective,randomized controlled and open-label trial,the PATH-PCI trial randomized CCS patients undergoing PCI into standard group or personalized group from December 2016 to February 2018,and underwent a 180-day follow-up evaluation.The personalized group received PAT based on a novel platelet function test(PFT).The standard group received standard antiplatelet therapy(SAT).The primary endpoint was the occurrence of net adverse clinical events(NACEs).The secondary endpoint was major adverse cardiac and cerebrovascular events(MACCEs),bleedings and the components of the primary endpoint event.Subsequently,all patients were divided into smokers and nonsmokers according to their smoking status for subgroup analysis to clarify the effect of smoking on the efficacy and safety of PAT.Results: The study cohort consisted of 2285 CCS patients: smokers(n=1170)and nonsmokers(n=1115).After analysis,we found no statistically significant difference in the incidence of NACEs and bleeding events between personalized group and standard group regardless of smoking status(P>0.05).In smokers,PAT reduced major adverse cardiovascular and cerebrovascular events(MACCEs)by 48.7%(3.0% vs.5.9%,HR=0.513,95%CI: 0.290-0.908,P=0.022),compared with SAT.In nonsmokers,PAT reduced MACCEs and major adverse cardiovascular events(MACEs)by 51.5%(3.3% vs.6.7%,HR=0.485,95%CI: 0.277-0.849,P=0.011)and 63.5%(1.8% vs.4.9%,HR=0.365,95%CI: 0.178-0.752,P=0.006),respectively.In addition to smoking,a common cardiovascular risk factor,we further explored the efficacy and safety of PAT for CCS patients of different ages.Further subgroup analysis on age revealed that PAT can reduce ischemic events(P＜0.05),but not increase bleedings(P>0.05),in patients under the age of 65 years.However,there was no statistically significant difference between PAT and SAT in terms of the risk of ischemic or bleeding events after PCI in elderly CCS patients(P>0.05).Conclusion:PAT is effective in CCS patients undergoing PCI,regardless of smoking status.Smoking weakens the efficacy of PAT and has no impact on the safety of PAT.PAT greatly improves the prognosis of CCS patients under the age of 65 years.