Osmancik Pavel P, Bednar Frantisek, Pavkova Leona, Tousek Petr, Stros Petr, Jirasek Karel
Cardiocenter, Department of Cardiology, Charles University, University Hospital Kralovske Vinohrady Prague, Czech Republic.
Blood Coagul Fibrinolysis. 2008 Dec;19(8):807-12. doi: 10.1097/MBC.0b013e3283169223.
The aim of the study was to compare platelet activity between patients with an occlusion of bypass graft after coronary artery bypass graft surgery and restenosis after percutaneous coronary intervention (PCI); that is, between patients with reappearance of ischemia after two different kinds of coronary revascularization. Thirty patients were studied in a cross-sectional designed study. Fifteen of them were patients with the worst bypass graft patency from Prague-4 study (control protocol-driven coronary angiography performed at 1 year after surgery; originally 47 bypass grafts implanted, 94% of venous grafts occluded). The remaining 15 were patients with restenosis 3-12 months after PCI. Blood samples were drawn at least 12 weeks after coronary angiography. Platelet activity was determined by membrane expression of P-selectin (CD62P, % of positive cells) by flow cytometry, aggregability by ADP aggregometry. Data are expressed as mean +/- SEM. Both groups were similar with respect to age, BMI and presence of diabetes mellitus. No patient suffered from acute coronary syndrome. P-selectin expression was significantly higher in the patients with restenosis compared with patients with bypass graft occlusion (1.96 +/- 0.07 vs. 0.77 +/- 0.03, P < 0.001, Wilcoxon test). ADP aggregometry was not different between groups (55.5 +/- 1.1 vs. 56.1 +/- 0.8, P = NS). Higher platelet activity is present in the patients with restenosis after PCI compared with the patients with the occlusion of bypass graft. Platelet activity play more important role in the development of restenosis after PCI compared with the occlusion of bypass graft after coronary artery bypass graft surgery, at least in the period up to 1 year after revascularization.
本研究的目的是比较冠状动脉旁路移植术后旁路移植物闭塞患者与经皮冠状动脉介入治疗（PCI）后再狭窄患者之间的血小板活性；即比较两种不同冠状动脉血运重建术后出现缺血复发的患者之间的血小板活性。在一项横断面设计研究中对30名患者进行了研究。其中15名是来自布拉格-4研究中旁路移植物通畅情况最差的患者（术后1年进行对照方案驱动的冠状动脉造影；最初植入47个旁路移植物，94%的静脉移植物闭塞）。其余15名是PCI术后3 - 12个月出现再狭窄的患者。在冠状动脉造影至少12周后采集血样。通过流式细胞术检测P-选择素（CD62P，阳性细胞百分比）的膜表达来确定血小板活性，通过ADP聚集试验检测聚集性。数据以平均值±标准误表示。两组在年龄、体重指数和糖尿病存在情况方面相似。没有患者患有急性冠状动脉综合征。与旁路移植物闭塞患者相比，再狭窄患者的P-选择素表达显著更高（1.96±0.07对0.77±0.03，P<0.001，Wilcoxon检验）。两组之间的ADP聚集试验结果无差异（55.5±1.1对56.1±0.8，P =无显著性差异）。与旁路移植物闭塞患者相比，PCI术后再狭窄患者的血小板活性更高。与冠状动脉旁路移植术后旁路移植物闭塞相比，血小板活性在PCI术后再狭窄的发生中起更重要的作用，至少在血运重建后1年的时间段内是这样。
