Terres W, Hamm C W, Ruchelka A, Weilepp A, Kupper W
Department of Cardiology, Eppendorf University Hospital, Hamburg, Germany.
J Cardiovasc Pharmacol. 1992 Feb;19(2):190-3. doi: 10.1097/00005344-199202000-00006.
Restenosis after percutaneous transluminal coronary angioplasty (PTCA) was shown not to be preventable by antiplatelet therapy; residual platelet function under treatment with platelet inhibitors could be one cause of this. Therefore, in a prospective investigation, residual platelet function was assessed in 98 patients treated with acetylsalicylic acid (ASA) on three occasions during the first 3 months after successful PTCA. Control cardiac catheterization was obtained in 75 of these patients (77%) with 82 dilated stenoses 173 +/- 117 days after PTCA. Restenosis, defined as diameter stenosis greater than or equal to 50% at control angiography, occurred in 41% of the dilated vessels, and 43% of patients experienced restenosis in at least one vessel. The in vitro platelet aggregatory response to either ADP (0.5, 1, and 10 microM) or collagen (1 and 5 mg/L) as aggregating agents did not differ between patients with and without restenosis. In addition, neither the collagen-stimulated in vitro synthesis of thromboxane nor the basal or prostaglandin E1-stimulated concentrations of cyclic AMP in platelet-rich plasma (PRP) was different in the two groups. There was no significant correlation between any of the parameters of platelet function assessed and the change in coronary luminal diameter observed between immediately after PTCA and control coronary angiography. The mean dose of ASA ingested during follow-up was also not a determinant of the occurrence of restenosis. Thus, residual platelet function under treatment with ASA as measured in vitro in this study, did not influence the occurrence of restenosis after successful PTCA.
经皮腔内冠状动脉成形术（PTCA）后再狭窄不能通过抗血小板治疗预防；血小板抑制剂治疗下的残余血小板功能可能是原因之一。因此，在一项前瞻性研究中，对98例成功PTCA后前3个月内三次接受乙酰水杨酸（ASA）治疗的患者评估了残余血小板功能。其中75例患者（77%）在PTCA后173±117天进行了对照心脏导管检查，有82处扩张狭窄。对照血管造影时直径狭窄大于或等于50%定义为再狭窄，41%的扩张血管出现再狭窄，43%的患者至少有一处血管发生再狭窄。有再狭窄和无再狭窄患者对作为聚集剂的ADP（0.5、1和10微摩尔）或胶原（1和5毫克/升）的体外血小板聚集反应无差异。此外，两组中胶原刺激的血栓素体外合成以及富血小板血浆（PRP）中基础或前列腺素E1刺激的环磷酸腺苷浓度均无差异。PTCA后即刻与对照冠状动脉造影之间观察到的冠状动脉管腔直径变化与所评估的任何血小板功能参数之间均无显著相关性。随访期间摄入的ASA平均剂量也不是再狭窄发生的决定因素。因此，本研究中体外测量的ASA治疗下的残余血小板功能并未影响成功PTCA后再狭窄的发生。
