High on-clopidogrel platelet reactivity (HPR) associates with ischemic risk in patients after percutaneous intervention (PCI). This study aimed to evaluate the association of HPR as assessed by multiple electrode aggregometry (MEA) with ischemic, thromboembolic, and bleeding risk in patients with atrial fibrillation (AF) undergoing PCI. Patients with AF and an indication for oral anticoagulation (OAC) were included in this prospective cohort study on day 1–3 after PCI. Platelet aggregation [U] was analyzed by MEA. HPR and low platelet reactivity (LPR) were defined as ADP-induced aggregation ≥ 46 U and ≤ 18 U, respectively. TRAP-6-induced aggregation reference was 94–156 U. The primary outcome was time to all-cause death, myocardial infarction, or stroke at 6 months. The secondary outcome was time to non-major clinically relevant bleedings or major bleedings. 159 patients were enrolled between May 2020 and May 2021. The median age was 78 years (interquartile range 72–82) and 111 (70%) were male. Median ADP- and TRAP-induced aggregation were 12 (6–17) and 49 (35–68) U, respectively. 147 (93%) patients had a low overall aggregability. HPR was detected in 2 patients (1%) and 125 (79%) had LPR. ADP-induced aggregation did not significantly associate with the primary outcome (r = 0.081, p = 0.309) but correlated inversely with bleeding risk (r = − 0.201, p = 0.011). HPR status as assessed by MEA among patients with AF after PCI was rare and overall aggregability was low. Conventional cut-off values for HPR might be inappropriate for these patients. ADP-induced aggregation might be helpful to identify patients at risk for bleeding.

氯吡格雷血小板反应性 (HPR) 高与经皮介入治疗 (PCI) 后患者的缺血风险相关。本研究旨在评估通过多电极聚集测量 (MEA) 评估的 HPR 与接受 PCI 的房颤 (AF) 患者的缺血、血栓栓塞和出血风险之间的关系。 PCI 后第 1-3 天的前瞻性队列研究纳入了患有 AF 且有口服抗凝 (OAC) 指征的患者。通过 MEA 分析血小板聚集 [U]。 HPR 和低血小板反应性 (LPR) 分别定义为 ADP 诱导的聚集≥ 46 U 和 ≤ 18 U。 TRAP-6 诱导的聚集参考值为 94-156 U。主要结局是 6 个月时发生全因死亡、心肌梗死或中风的时间。次要结局是发生非重大临床相关出血或大出血的时间。 2020 年 5 月至 2021 年 5 月期间入组了 159 名患者。中位年龄为 78 岁（四分位距 72-82），其中 111 名患者（70%）为男性。 ADP 和 TRAP 诱导的聚集中位数分别为 12 (6-17) 和 49 (35-68) U。 147 名 (93%) 患者的总体可聚合性较低。 2 名患者 (1%) 检测到 HPR，125 名患者 (79%) 检测到 LPR。 ADP 诱导的聚集与主要结局没有显着相关性（r = 0.081，p = 0.309），但与出血风险呈负相关（r = − 0.201，p = 0.011）。 PCI 术后房颤患者中通过 MEA 评估的 HPR 状态很少见，总体可聚合性较低。 HPR 的常规截止值可能不适合这些患者。 ADP 诱导的聚集可能有助于识别有出血风险的患者。