Hochholzer Willibald, Trenk Dietmar, Bestehorn Hans-Peter, Fischer Benjamin, Valina Christian M, Ferenc Miroslaw, Gick Michael, Caputo Angelika, Büttner Heinz Joachim, Neumann Franz-Josef
Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
J Am Coll Cardiol. 2006 Nov 7;48(9):1742-50. doi: 10.1016/j.jacc.2006.06.065. Epub 2006 Oct 17.
Our prospective study tested the hypothesis that the 30-day clinical outcome of elective percutaneous catheter intervention (PCI) differs between strata defined by quartiles of platelet aggregation after loading with 600 mg clopidogrel.
Platelet responses after loading with clopidogrel are highly variable. The impact of this variability on the peri-interventional risk of patients undergoing PCI has not been investigated prospectively.
Our study included 802 consecutive patients undergoing elective coronary stent placement. Before PCI, patients received a loading dose of 600 mg clopidogrel followed by 75 mg daily. Primary end point was the 30-day composite of death, myocardial infarction, and target lesion revascularization (major adverse cardiac events [MACE]). Platelet aggregation was assessed immediately before PCI by optical aggregometry (5 micromol/l adenosine diphosphate).
During 30-day follow-up, 15 patients (1.9%) incurred MACE (3 deaths, 8 myocardial infarctions, 8 target lesion revascularizations). Quartiles of platelet aggregation were <4%, 4% to 14%, 15% to 32%, and >32%. Thirty-day MACE differed significantly (p = 0.034) between quartiles of platelet aggregation. It was 0.5% in the first quartile, 0.5% in the second, 3.1% in the third, and 3.5% in the fourth. Platelet aggregation above the median carried a 6.7-fold risk (95% confidence interval 1.52 to 29.41; p = 0.003) of 30-day MACE. Multivariable logistic regression analysis, including pertinent covariables, confirmed platelet aggregation as a significant independent predictor of 30-day MACE (adjusted odds ratio per 10% increase in platelet aggregation 1.32, 95% confidence interval 1.04 to 1.61; p = 0.026).
The level of platelet aggregation immediately before elective coronary stenting in patients pre-treated with a high loading dose of clopidogrel is correlated with early outcome after the procedure.
我们的前瞻性研究检验了以下假设：在给予600毫克氯吡格雷负荷剂量后，根据血小板聚集四分位数定义的分层中，择期经皮导管介入治疗（PCI）的30天临床结局存在差异。
氯吡格雷负荷剂量后的血小板反应高度可变。这种变异性对接受PCI患者围介入期风险的影响尚未进行前瞻性研究。
我们的研究纳入了802例连续接受择期冠状动脉支架置入术的患者。PCI术前，患者接受600毫克氯吡格雷负荷剂量，随后每日服用75毫克。主要终点是30天内死亡、心肌梗死和靶病变血运重建的复合终点（主要不良心脏事件 [MACE]）。PCI术前通过光学聚集法（5微摩尔/升二磷酸腺苷）评估血小板聚集情况。
在30天随访期间，15例患者（1.9%）发生MACE（3例死亡、8例心肌梗死、8例靶病变血运重建）。血小板聚集四分位数分别为<4%、4%至14%、15%至32%和>32%。血小板聚集四分位数之间的30天MACE差异有统计学意义（p = 0.034）。第一四分位数为0.5%，第二四分位数为0.5%，第三四分位数为3.1%，第四四分位数为3.5%。血小板聚集高于中位数者发生30天MACE的风险为6.7倍（95%置信区间1.52至29.41；p = 0.003）。多变量逻辑回归分析，包括相关协变量，证实血小板聚集是30天MACE的显著独立预测因素（血小板聚集每增加10%，调整后的优势比为1.32，95%置信区间1.04至1.61；p = 0.026）。
在接受高负荷剂量氯吡格雷预处理的患者中，择期冠状动脉支架置入术前的血小板聚集水平与术后早期结局相关。
